December 5, 2017
An electronic upgrade has given health providers at Oregon Health & Science University Hospital greater access to patients’ end-of-life care wishes.
The recently implemented upgrade allows OHSU Hospital providers to electronically retrieve information from Oregon’s Physician Orders for Life-Sustaining Treatment registry.
Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care in Portland, says the innovation has boosted OHSU’s ability to provide the kinds of end-of-life care that patients want — and only what they want.
The upgrade is especially important for patients who cannot make their wishes known when they are brought to the hospital. “You may not know that the patient has a form in the registry,” says Tolle, who also is an internist and professor of medicine at OHSU. “The patient may be too ill to speak, and there may not yet be anyone with them who knows anything about them.”
Tolle is a founder of the POLST program, which was launched in the early 1990s. Back then, she recalls, it was not unusual for patients at the end of life to be given more intensive care than they wanted. “Information did not flow effectively from one setting to another for patients who were incapable of speaking for themselves,” she says.
In 2009, POLST was expanded into a statewide registry that providers could call. Going statewide improved the flow of information, but the system was limited by the preponderance of paper records, Tolle says.
“POLST worked great if emergency medical personnel were called and it was visible in the home,” Tolle says. “There were bright pink POLST forms on the refrigerator, or maybe the POLST magnet. But sometimes it couldn’t be found. You have to be paper and electronic at the same time for this system to work.”
December 5, 2017