THE INACCESSIBILITY OF ADVANCE DIRECTIVES ON TRANSFER FROM AMBULATORYTO ACUTE-CARE SETTINGS

Objective.-To investigate the accessibility of patients' previously ex ecuted advance directives during an acute hospitalization. Design.-Ret rospective chart review. Setting.-A large metropolitan teaching hospit al, a 514-bed skilled nursing facility, a geriatrics ambulatory care c linic, and a geriatrics group practice office. Patients.-One hundred f ourteen geriatric patients who had previously executed an advance dire ctive. Main Outcome Measures.-The medical records of 180 admissions ov er 3 years, 1991 through 1993, were reviewed for documentation of pati ents' advance directive status. Results.-Twenty-six percent of patient s who had previously executed advance directives had their directives recognized during their hospitalization. Of the subgroup of patients w ho were judged not to have the capacity to make medical decisions duri ng their admissions, 26% (14/53) had their directives recognized. When the advance directive was recognized, it appeared to influence treatm ent decisions in 12 (86%) of 14 cases. Conclusions.-Previously execute d advance directives are not accessible when patients are admitted to hospitals for acute illness. When such directives are recognized, they are used to influence medical treatment decisions. Further research i s needed to define and overcome barriers to this inaccessibility.