A better way to document patient end-of-life treatment wishes

For decades, Oregon has led the country in systems change to assure the treatment wishes of those nearing the end of life are consistently honored. The last thing any patient wants is to have clearly documented their wishes through a delicate and thoughtful conversation with their health care professional and family members, and by filling out Physician Orders for Life-Sustaining Treatment (POLST) form, and then not have those wishes honored.

That’s why Oregon Health & Science University launched ePOLST, a fully integrated online version of POLST. ePOLST will assist OHSU, and other health systems across the country that use the Vynca software, in more accurately recording and accessing the wishes of patients who are nearing the end of life.

Harriet, the patient whose POLST form could not be found

A better system

Why do we need a new system? Because there are too many stories like those of Harriet, a 94-year-old Oregon woman, now deceased, who signed a POLST form with her doctor two years ago. She needed to go to the hospital because her broken hip caused so much pain, but being admitted to intensive care was against her wishes.

Health care providers weren’t able to find her POLST form. Harriet’s family hopes that OHSU’s new ePOLST system will make POLST orders available right away so that other families can avoid the anguish of having to stop unwanted treatments.

The POLST form was created in 1990 in an effort to ensure the wishes of those with advanced illness or frailty are followed. POLST programs have been adopted or are in development in 43 states across the country.

POLST forms are strongly associated with desired care received. A survey of patients showed that less than 10 percent of patients want to die in the hospital. Unfortunately, without a POLST form, four times that many still do.

Knowing we needed to continue evolving the POLST program, we connected with Ryan Van Wert, M.D., the co-founder of Vynca and a critical care physician who comes from Stanford Biodesign.

Having seen the end-of-life care wishes of patients ignored simply because they couldn’t find their POLST form, his team worked collaboratively with OHSU’s EPIC support team, the OHSU Center for Ethics in Health Care, Oregon POLST Registry and Oregon POLST to pilot ePOLST, which launched in April.

Phase One

In the first phase of the launch, ePOLST allows OHSU clinicians to electronically and more quickly and accurately submit a POLST form, drastically reducing the need for paper forms, which are error-prone. (The current statewide error rate for paper POLST forms submitted to the Oregon POLST Registry is 18 percent.)

Vynca team that developed ePOLST

OHSU clinicians can also now easily view a patient’s POLST form, which is located at the top of their EPIC electronic health record, if they have one.

This is critical in crisis situations where care teams are making decisions about treatment options.

Phase Two

In the next phase, OHSU clinicians will be able to electronically search the Oregon POLST Registry through ePOLST, which will make it easier to find POLST forms from other health care systems.

In Oregon, more than 250,000 POLST forms have been submitted to the registry since its inception in 2009.

More than 5,000 health care professionals have called the registry seeking forms in a time of urgent need — 2,000 of those patients had POLST forms provided to guide their care.

What’s next?

After almost two years, we’re happy to report the system is working well and is on track for the next phase! The fewer errors we have with POLST forms, and the easier we can find forms, the better care we can give to our patients, while also respecting their wishes.

Learn more about OHSU’s POLST Paradigm Initiative, or get involved with POLST Oregon.

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Susan Tolle, M.D. is the Director of the OHSU Center for Ethics in Health Care and Chair of the Oregon POLST Task Force.

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Comments

  1. Great work!

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