DOI: 10.1097/01.ccm.0000474193.88407.61

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Issn Print: 0090-3493

Publication Date: 2015/12/01


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365: DISPARITIES IN ADVANCE DIRECTIVE USE BY INDIGENT PATIENTS IN THE SURGICAL/TRAUMA INTENSIVE CARE UNIT

Zuhdi Abdo; Natalie Provenzale; Brian Williams

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Excerpt

Learning Objectives: Decisions regarding end-of-life care in the ICU are frequently complicated when patients do not have an Advance Directive (AD). The Department of Health and Human Services reports that the US national average of medical and surgical ICU patients with an AD is between 18–30%. We hypothesized that the predominantly indigent patient population admitted with an AD to our Surgical/Trauma Intensive Care Unit (STICU) is significantly lower at 5%.
Methods: We retrospectively reviewed the electronic medical records (EMR) of patients admitted to the STICU of an urban, Level 1 trauma, safety-net hospital from Jan 1 to Dec 31, 2014. We then compared the number of patients admitted to the STICU with an AD to the total number of patients admitted to the STICU over that time period.
Results: There were 1,046 patients admitted to the STICU in 2014. Of those, 799 (76.4%) had an AD status documented at the time of admission. The other 247 (23.6%) did not have an AD status documented upon admission. Since we could not confirm their AD status, these patients were not included in the final analysis. Of the 799 confirmed patients, 41 (5.13%) had an AD documented at the time of admission to the STICU.
Conclusions: This single institution review supports our hypothesis that approximately 5% of all admissions to our Surgical/Trauma ICU have an Advance Directive upon admission. This is significantly lower than the national average of 18–30%, and represents a potential disparity in our largely indigent patient population. Future efforts will require data validation to determine the actual AD status of patients who have none documented in their EMR, assessing the role ADs have on patient and family outcomes, and implementing methods to increase the AD rate for patients admitted to the STICU.

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