Mr. M, an elderly man with chronic lung disease, was found on the floor of his kitchen by a neighbor, who spotted his prone body through an open window. Emergency medical personnel noted that he had a weak pulse and low oxygen level. Labs and imaging in the emergency department suggested that he was in respiratory failure from pneumonia, and he was quickly started on IV antibiotics and fluid support. However, his breathing grew more tenuous during his stay in the emergency department. The physician attending to him did not have access to the details of Mr. M’s medical history or end-of life-wishes, since his hospital and primary care physician had different electronic medical record (EMR) systems. Mr. M later experienced cardiopulmonary arrest in the emergency department, requiring a full resuscitation, intubation, and transfer to the intensive care unit.
How Health Care Providers Can Ensure Patients’ End-of-Life Wishes Are Known
Advance care planning (ACP) is widely recognized as something that should be a central element of the way that patients, their physicians, and their families together decide which end-of-life care to provide. Efforts to boost participation in these conversations include the introduction of new billing codes to financially incentivize primary care physicians to discuss ACP, as well as grassroots advocacy efforts to highlight the importance of discussing end-of-life wishes. And yet these efforts to popularize the creation of advance care documents do not address a key issue: access to them. Given the current fragmented state of health care, new solutions are needed. The authors’ recommendations include: Build a national electronic registry, obtain federal support for a national standard and regulations, create billing codes for advance care planning, and promote local solutions.