The following is a quote from an Emergency Medicine physician I interviewed for a study about palliative care in the emergency department:
I had 2 or 3 instances that involved a very angry phone call from a primary care physician or an oncologist, who understandably had had a several month conversation with this patient, finally getting him to move to this DNR/DNI comfort measure state, and then they come in and now we have them intubated in the ICU, you know largely through miscommunication. Part of the problem involves being able to communicate effectively with people who know the patients better—their primary care providers, their oncologists— but who aren’t there at the ER at the time the patient comes in.”
This is a serious problem folks.
We spend a tremendous amount of energy working to help patients engage in advance care planning. We have pushed the envelope on getting patients to make plans in the outpatient setting, before they are seriously ill and having a “code status” conversation in the hospital with a doctor they’ve just met for the first time.
How often is all of this work for naught? How often do the best laid plans never make it to the hospital? How often is the patient picked up by the ambulance, seen in the emergency department, or transferred to the intensive care unit WITHOUT their POLST, DNR order, or advance directive?