 |
|
Promoting Inpatient Directives About Life-Sustaining Treatments in a Community HospitalResults of a 3-Year Time-Series Intervention Trial
Brendan M. Reilly, MD;
Michael Wagner, MD;
C. Richard Magnussen, MD;
James Ross;
Louis Papa, MD;
Jeffrey Ash, MD
Arch Intern Med. 1995;155(21):2317-2323.
Abstract
| |
Background
Hospitalization presents an opportunity for physicians to discuss advance directives with patients and to encourage completion of health care proxies.
Objective
To prospectively promote discussion and documentation of treatment-specific directives about life-sustaining interventions (cardiopulmonary resuscitation, admission to critical care units, mechanical ventilation, electrical cardioversion, and vasopressor therapy) among unselected medical inpatients in a community teaching hospital.
Methods
We conducted a time-series intervention trial from January 1,1991, through June 30 1993, divided into three phases. During the education phase, we provided reminders, education, and feedback to attending physicians; during the intervention phase, we promoted a new documentation form for directives to be used by attending physicians; during the control phase, no interventions occurred. We studied consecutive patients (N=1780) admitted to the hospital acute medical service in each of the following 10 periods: three in the education phase (n=598), three in the intervention phase (n=826), and four in the control phase (n=356). The primary outcome measures were the frequency and content of directives documented by attending physicians in their patients' hospital charts. Secondary outcome measures included physicians' and patients' attitudes about directives, surveyed repeatedly.
Results
The proportion of inpatients with directives increased significantly during the intervention phase (62.5% vs 23.6% during the education phase and 25.3% during the control period, P<.001, Pearson  2 test). During the final intervention phase, 227 (83.2%) of 273 inpatients had directives documented in the hospital chart. Increases in clinically important ("impact") directives usually involved intensive care, not do-not-resuscitate status. Overall, 366 (86.7%) of 422 physician-attested directives agreed with the treatment preferences of interviewed patients ( ranges, 0.53 to 0.79). Physicians' attitudes about and interest in directives improved.
Conclusions
Institutional interventions can facilitate attending physicians' documentation of treatment-specific directives about life-sustaining care for most medical inpatients. More research is needed to confirm the effect of these efforts on quality and cost of hospital care, patients' autonomy, and their eventual execution of durable directives and proxies.
(Arch Intern Med. 1995;155:2317-2323)
Author Affiliations
From the Department of Medicine, St Mary's Hospital, University of Rochester (NY) School of Medicine and Dentistry. Dr Reilly is now affiliated with the Department of Medicine, Cook County Hospital, Chicago, Ill.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Role of advance directives in palliative care units: a prospective study
Pautex et al.
Palliat Med 2008;22:835-841.
ABSTRACT
Controlling Death: The False Promise of Advance Directives
Perkins
ANN INTERN MED 2007;147:51-57.
ABSTRACT
| FULL TEXT
Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff
Sahm et al.
J. Med. Ethics 2005;31:437-440.
ABSTRACT
| FULL TEXT
Evaluation of a labeling system to indicate the presence of an advance directive in a hospital medical record
Wallace and Desbiens
Int J Qual Health Care 2004;16:333-335.
ABSTRACT
| FULL TEXT
Determining resuscitation preferences of elderly inpatients: a review of the literature
Frank et al.
CMAJ 2003;169:795-799.
ABSTRACT
| FULL TEXT
A messy necessary end: Health care proxies need our support
Goldblatt
Neurology 2001;56:148-152.
ABSTRACT
| FULL TEXT
Time To Move Advance Care Planning Beyond Advance Directives
Perkins
Chest 2000;117:1228-1231.
FULL TEXT
Impediments to Writing Do-Not-Resuscitate Orders
Eliasson et al.
Arch Intern Med 1999;159:2213-2218.
ABSTRACT
| FULL TEXT
Practice Parameter: The Care of the Patient with Amyotrophic Lateral Sclerosis (An Evidence-Based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology
Miller et al.
Neurorehabil Neural Repair 1999;13:93-107.
Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology
Miller et al.
Neurology 1999;52:1311-1311.
FULL TEXT
A New Model of Advance Care Planning: Observations From People With HIV
Martin et al.
Arch Intern Med 1999;159:86-92.
ABSTRACT
| FULL TEXT
The Patient Self-Determination Act and Advance Directive Completion in Nursing Homes
Bradley et al.
Arch Fam Med 1998;7:417-423.
ABSTRACT
| FULL TEXT
What Do Patients Express as Their Preferences in Advance Directives?
Gross
Arch Intern Med 1998;158:363-365.
ABSTRACT
| FULL TEXT
Death and End-of-Life Planning in One Midwestern Community
Hammes and Rooney
Arch Intern Med 1998;158:383-390.
ABSTRACT
| FULL TEXT
Publications in Subspecialty Journals on End-of-Life Ethics
Heffner et al.
Arch Intern Med 1997;157:685-690.
ABSTRACT
|
