ADVANCE DIRECTIVES IN THE EMERGENCY DEPARTMENT - TOO FEW, TOO LATE

Objective: To determine: 1) the number of patients arriving at the ED who had executed an advance directive (AD), 2) how many of the patient s who had an AD brought the AD with them, and 3) whether those patient s who did not have an AD had ever discussed ADs with their primary car e providers (PCPs) or had ever heard of an AD. Methods: A cross-sectio nal. observational survey of a convenience sample of high-risk patient s presenting to the ED of a university hospital was performed. Patient s presenting to the ED for acute complaints who were elderly or had an underlying disease that suggested a risk of death in the near future were considered high risk. Results: Of the 238 patients surveyed, 90% had PCPs. However, only 22% had ADs. Of these, only 23% brought the AD to the ED. Of the patients who did not have ADs, 95% had never discus sed ADs with their PCPs, and 42% did not know what an AD was. Blacks w ere less likely than whites to have ADs (p < 0.0002) or to know about them (p < 0.004). Conclusion: The majority of high-risk patients prese nting to this ED do not have ADs. Among those highrisk patients who di d have ADs, fewer than 25% brought the ADs with them, The development of ADs for high-risk patients and the availability of ADs in the ED ar e woefully inadequate, Emergency physicians need to collaborate with P CPs to remedy these deficiencies.