Decisions by Default: Incomplete and Contradictory MOLST in Emergency Care

Clemency, Brian M.; Cordes, Colleen; Lindstrom, Heather A.; Basior, Jeanne M.; Waldrop, Deborah P.

doi:10.1016/j.jamda.2016.07.032

Cited by 28 publications

(20 citation statements)

References 18 publications

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“…[1] While POLST programs have expanded rapidly over the last decade, some notable concerns have been raised. These concerns include the threat to patient safety arising from physicians misunderstanding POLST forms, [2–5] and fears that POLST forms may “distract from the broader social goals of promoting informed decisions about health care options among seriously ill patients.” [6] Attempts to objectively evaluate the impact of POLST programs have relied heavily on data collected from nursing homes, [7] and from Oregon, where health care professionals are mandated to enter forms in a state-wide registry unless a patient opts out. [8, 9]…”

Section: Introductionmentioning

confidence: 99%

Demonstrating the impact of POLST forms on hospital care requires information not contained in state registries

et al. 2019

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Background Physician Orders for Life-Sustaining Treatment (POLST) programs have expanded rapidly, but evaluating their impact on hospital care is challenging. Objectives To demonstrate how careful study design can reveal POLST’s impact at hospital admission and why analyses of state registry data are unlikely to capture POLST’s effects. Design Prospective cohort study. Setting and participants Adult in-patients with Do Not Intubate and/or Do Not Resuscitate (DNR/I) orders in the electronic medical record at the time of discharge from Johns Hopkins Hospital over 18 months. For patients with unplanned readmissions within 30 days, records were reviewed to determine if a Maryland Medical Order for Life-Sustaining Treatment (MOLST) form was presented and for the time from readmission to a DNR/I order in the EMR. Analyses were stratified by whether patients could communicate or were accompanied by a proxy at readmission. Results Among 1,507 patients with DNR/I orders at discharge, 124 (8%) had unplanned readmissions, 112 (90%) could communicate or were accompanied by a proxy at readmission, and 12 (10%) could not communicate and were unaccompanied. For patients who were unaccompanied and could not communicate, MOLST significantly decreased the median time from readmission to DNR/I order (1.2 vs 27.1 hours, P = .001), but this association was greatly attenuated among patients who could communicate or were accompanied by a proxy (16.4 vs 25.4 hours P = .10). Conclusion Among patients who wanted to avoid intubation and/or CPR, MOLST forms were protective when the patient was unaccompanied by a healthcare proxy at admission and could not communicate. Fewer than 10% of patients met these criteria during unplanned readmissions, and state registry data does not allow this sub-population to be identified.

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Section: Introductionmentioning

confidence: 99%

Demonstrating the impact of POLST forms on hospital care requires information not contained in state registries

et al. 2019

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“…Considerations for future collaboration will also include the development of interventions to support ED clinicians in recognizing their patient’s palliative care needs and responding to those needs. For example, it has been established that many patients arrive to the emergency department with outdated, incomplete or missing Medical Orders for Life Sustain Treatments (MOLST) paperwork leading to potentially invasive and unnecessary interventions 24 . This issue is made worse during COVID times as patients and their loved ones/advocates are often physically separated due to visitation restrictions.…”

Section: Discussionmentioning

confidence: 99%

A Pivot to Palliative: An Interdisciplinary Program Development in Preparation for a Coronavirus Patient Surge in the Emergency Department

Dundin¹,

Siegert²,

Miller³

et al. 2020

Journal of Emergency Nursing

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The current literature on palliative care in the emergency department indicates the prominent need for emergency nurses and palliative care clinicians to better understand their respective roles and responsibilities to improve palliative care for ED patients. This article contributes a program template, process and educational and support resources for emergency nurses focused on improving palliative care in the emergency department during the coronavirus disease pandemic. Key implications for emergency nursing practice found in this article are the potential to tailor, replicate, and test our program to improve palliative care in other ED settings.

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“…Studies did not pay adequate attention to the reliability and validity of instruments, in particular to the methodological challenges of using documentation to assess patient preferences and EoL care. These include difficulties with response shift 31 (i.e., the fact that people's values and choices change over time); a lack of specificity and consistency of documentation (documentation may be incoherent and contain incompatible requests) 32 and the fact that chart reviews are unreliable and prone to bias and error. 33 All these factors affect standard psychometric indices such as reliability and validity.…”

Section: Discussionmentioning

confidence: 99%

How Well Do Current Measures Assess the Impact of Advance Care Planning on Concordance Between Patient Preferences for End-of-Life Care and the Care Received: A Methodological Review

Johnson

Butow

Kerridge

et al. 2018

Journal of Pain and Symptom Management

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Methodological variations and weaknesses compromise the validity of study results, and prevent meaningful comparisons between studies or synthesis of the results. Effectively evaluating whether ACP interventions enhance a patient's capacity to receive the care they want requires harmonization of research. This demands standardization of methods across studies, validating of instruments, and consensus based on a consistent conceptual framework regarding what constitutes a meaningful outcome measure.

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Decisions by Default: Incomplete and Contradictory MOLST in Emergency Care

Cited by 28 publications

References 18 publications

Demonstrating the impact of POLST forms on hospital care requires information not contained in state registries

Demonstrating the impact of POLST forms on hospital care requires information not contained in state registries

A Pivot to Palliative: An Interdisciplinary Program Development in Preparation for a Coronavirus Patient Surge in the Emergency Department

How Well Do Current Measures Assess the Impact of Advance Care Planning on Concordance Between Patient Preferences for End-of-Life Care and the Care Received: A Methodological Review

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