Advance Directives in the Emergency Department: Too Few, Too Late
Article first published online: 29 SEP 2008
© 1996 Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 3, Issue 1, pages 50–53, January 1996
How to Cite
Ishihara, K. K., Wrenn, K., Wright, S. W., Socha, C. M. and Cross, M. (1996), Advance Directives in the Emergency Department: Too Few, Too Late. Academic Emergency Medicine, 3: 50–53. doi: 10.1111/j.1553-2712.1996.tb03303.x
- Issue published online: 29 SEP 2008
- Article first published online: 29 SEP 2008
- Received: March 13, 1995; revision received: June 12, 1995: accepted: June 17, 1995; updated: July 7, 1995.
- advanced directives;
- emergency department;
- living wills;
Objective:To determine: 1) the number of patients arriving at the ED who had executed an advance directive (AD), 2) how many of the patients who had an AD brought the AD with them, and 3) whether those patients who did not have an AD had ever discussed ADs with their primary care providers (PCPs) or had ever heard of an AD.
Methods: A cross-sectional, observational survey of a convenience sample of high-risk patients presenting to the ED of a university hospital was performed. Patients 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 discussed ADs with their PCPs, and 42% did not know what an AD was. Blacks were 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 presenting to this ED do not have ADs. Among those high-risk patients who did 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 are woefully inadequate. Emergency physicians need to collaborate with PCPs to remedy these deficiencies.