Emergency departments (ED) across the United States see many patients with advanced disease nearing the end of life. ED providers make many important decisions that impact a patient’s hospital course, including resuscitation decisions. When patients’ preferences are not known, treatment in the ED frequently defaults to maximally aggressive care. The Physician Orders for Life Sustaining Treatment (POLST) form has been shown to lead to more goal-concordant care for these patients by providing detailed instructions regarding end-of-life interventions, made by the patient and/or medical decision maker.
In this needs assessment study, we aimed to determine the level of awareness and understanding of the POLST form amongst providers at two ACGME accredited Emergency Medicine Residency programs. We assessed awareness by sending a 13 item survey to all residents, faculty, and advanced practice providers in the two EDs.
Of 205 questionnaires distributed, we received 63 responses (31%). Only 44% of responders reported using a POLST in the past year, and 40% did not feel comfortable interpreting and applying a POLST. Seventy percent of responders do not know where to locate this form. Our data suggests opportunities to educate ED personnel on locating and applying the POLST form. Interestingly, trainees reported a higher degree of familiarity and comfort with POLST forms when compared to staff physicians.
A significant minority of Emergency Department providers do not know how to properly apply a POLST form. As a result, we are designing an educational intervention to help ED providers better interpret, apply, and find the POLST form at their institutions. A post intervention questionnaire will be administered to gauge the effectiveness of our intervention.