Advance Care Planning Among Patients With Advanced Illness Presenting to the Emergency Department

Link to article at PubMed

J Emerg Med. 2023 Apr;64(4):476-480. doi: 10.1016/j.jemermed.2022.12.011. Epub 2023 Mar 28.


BACKGROUND: Advance care planning (ACP) benefits emergency department (ED) patients with advanced illness. Although Medicare implemented physician reimbursement for ACP discussions in 2016, early studies found limited uptake.

OBJECTIVE: We conducted a pilot study to assess ACP documentation and billing to inform the development of ED-based interventions to increase ACP.

METHODS: We conducted a retrospective chart review to quantify the proportion of ED patients with advanced illness with Physician Orders for Life-Sustaining Treatment (POLST) or coding of ACP discussion in the medical record. We surveyed a subset of patients via phone to evaluate ACP participation.

RESULTS: Of 186 patients included in the chart review, 68 (37%) had a POLST and none had ACP discussions billed. Of 50 patients surveyed, 18 (36%) recalled prior ACP discussions.

CONCLUSIONS: Given the low uptake of ACP discussions in ED patients with advanced illness, the ED may be an underused setting for interventions to increase ACP discussions and documentation.

PMID:36990851 | DOI:10.1016/j.jemermed.2022.12.011

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