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Casey MF, Price L, Markwalter D, et al. Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program. Am J Hosp Palliat Care. 2022;10499091211072850doi: 10.1177/10499091211072850.
Casey, M. F., Price, L., Markwalter, D., Bohrmann, T., Tsujimoto, T. M., Lavin, K., Hanson, L. C., Lin, F. C., & Platts-Mills, T. F. (2022). Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program. The American journal of hospice & palliative care, 10499091211072850. https://doi.org/10.1177/10499091211072850
Casey, Martin F, et al. "Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program." The American journal of hospice & palliative care vol. (2022): 10499091211072850. doi: https://doi.org/10.1177/10499091211072850
Casey MF, Price L, Markwalter D, Bohrmann T, Tsujimoto TM, Lavin K, Hanson LC, Lin FC, Platts-Mills TF. Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program. Am J Hosp Palliat Care. 2022 Jan 18;10499091211072850. doi: 10.1177/10499091211072850. Epub 2022 Jan 18. PMID: 35040696.
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Am J Hosp Palliat Care. 2022 Jan 18;10499091211072850. doi: 10.1177/10499091211072850. Epub 2022 Jan 18.

Advance Care Planning for Emergency Department Patients With COVID-19 Infection: An Assessment of a Physician Training Program.

The American journal of hospice & palliative care

Martin F Casey, Laiken Price, Daniel Markwalter, Tommy Bohrmann, Tamy Moraes Tsujimoto, Kyle Lavin, Laura C Hanson, Feng-Chang Lin, Timothy F Platts-Mills

Affiliations

  1. Department of Emergency Medicine, 6797University of North Carolina School of Medicine, Chapel Hill, NC, USA.
  2. Analytical Partners Consulting, LLC, Raleigh, NC, USA.
  3. Department of Biostatistics, 6797University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.
  4. Department of Psychiatry and UNC Palliative Care Program, 6797University of North Carolina School of Medicine, Chapel Hill, NC, USA.
  5. Division of Geriatric Medicine and UNC Palliative Care Program, Department of Medicine, 6797University of North Carolina School of Medicine, Chapel Hill, NC, USA.
  6. 592707Quantworks, Inc, Carrboro, NC, USA.

PMID: 35040696 DOI: 10.1177/10499091211072850

Abstract

OBJECTIVE: Coronavirus Disease 2019 (COVID-19) has heightened the importance of advance care planning (ACP), particularly in the emergency department (ED). The objective of this study was to determine the effect of an educational program for emergency physicians on ACP conversations in the ED during the COVID-19 pandemic.

DESIGN: This was an observational pre-/post-interventional study.

SETTING: This study was conducted at a Southeastern U.S. academic ED.

PARTICIPANTS: 143 patients with confirmed COVID-19 infection in the 2 weeks up to and including the ED encounter of interest (between March 26 and May 25, 2020) were included.

INTERVENTIONS: The primary intervention was an ACP training toolkit with three components: (1) an evidence-based guide to COVID-19 risk stratification, (2) education on language to initiate ACP conversations, and (3) modification of the electronic health record (EHR) to facilitate ACP documentation. Palliative care physicians also delivered a 60-minute ACP educational session for emergency medicine physicians.

OUTCOME MEASURES: The primary outcome was a composite of ACP activities including: (1) identification of a healthcare decision-maker (HCDM), (2) an order for a code status, or (3) a documented goals of care conversation.

RESULTS: There was a 25.4% (95% CI: 7.0-43.9) increase in the composite outcome of ED-based ACP. After adjustment for patient demographics and triage score, there was a non-statistically significant increase in ACP activity (OR = 2.71, 95% CI: 0.93-8.64; P = .08).

CONCLUSION: A rapid and simple physician-facing educational intervention demonstrated a trend, though lacking in statistical significance, towards increased ED-based ACP activities for patients with COVID-19.

Keywords: COVID-19; advance care planning; emergency medicine; geriatrics; goals of care; prognosis

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