Rs. Morrison et al., THE INACCESSIBILITY OF ADVANCE DIRECTIVES ON TRANSFER FROM AMBULATORYTO ACUTE-CARE SETTINGS, JAMA, the journal of the American Medical Association, 274(6), 1995, pp. 478-482
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.