Will an ER Doctor Find Your Client’s Advance Directive?

No. Not in the vast majority of cases, at any rate.
This is the troubling conclusion in 2 recent studies. Both were in Emergency Departments, both using electronic health records (EHR).

One study looked solely at patients over 65 — probably a sizeable portion of your clients. It found that:

• Most patients who said they’d completed an advance directive or other advance care planning (ACP) document had no advance directive available in the emergency department. In fact:
• Only 13% of all patients had an advance care planning document that the ER could find in the electronic record, although 59% said they had completed one.
• Furthermore, the patients in this study were exactly the seniors for whom it’s most important to have their advance directive:  they were over 80 years old or else over 65 with some risk of short-term mortality.

Strike one for assuming the Emergency Department will have your clients’ advance directives when they need them. So maybe part of the problem is that patients never actually gave their advance directive to the hospital? Could be.

• In fact, only 12.5% of patients said they had given these documents to the hospital previously.
• But even when patients reported that they had already given their advance directive to the hospital, their documents could not be found in the EHR in almost 70% of cases (69% to be exact). This is an abysmal record. Strike two.

So maybe the answer is having an electronic health record that shares information between the doctor’s office and the hospital, so at least if the patient’s doctor has the ACP document, the hospital can have access to it. But this study found that:

• For almost 80% of patients whose primary doctor was part of the same hospital system as the Emergency Department, no ACP document could be found in their records. Strike three.

In the second study, which surveyed emergency physicians, the most alarming finding was:

• Fewer than 1/3 of emergency room doctors felt “very confident” or “extremely confident” that they could find patients’ advance directive or other ACP documentation in the current EHR — when it exists!
  

These doctors also talked about the problems they face in trying to find an advance directive within the EHR. I reviewed many of these problems in my May 2016 blog post.

“The fact that we are not providing our patients with this assurance [that we know their preferences and provide care accordingly] is the most troubling aspect of these findings,” observes critical care physician Ryan Van Wert, MD. “This is a patient safety issue, and a true disservice to our most vulnerable patients.”

Clearly, relying on the doctor’s office, the hospital, or the Emergency Department’s medical records, even electronic ones, is not the current sole answer to making clients’ advance directives accessible. Especially in an emergency. And it won’t be the sole answer for a very long while. Other methods are necessary to ensure that your clients’ health care wishes can be known and followed.

Randi J. Siegel, MBA, is the President of DocuBank® (docubank.com), which ensures that the emergency information and healthcare directives of its 250,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

Academy Guest Blogger
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