Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation.
Tara Liberman, Regina Roofeh, Jessica Chin and 5 others
PMID 34649729WHAT IT FOUND
Remote nurses held goals-of-care calls with families of 64 emergency patients during visitation restrictions.
DNR, DNI, and MOLST were discussed, yet 48% remained Full Code and 80% were admitted to hospital.
Key findings
01A remote goals-of-care program was used for 64 patients referred from emergency departments between April and June 2020.
02Most conversations were with family (72%), and only 8% involved patients directly.
03After the conversations, 34% completed a health care proxy, 48% remained Full Code, and 80% were admitted to hospital.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no comparison group, so the results cannot show that the remote program changed patient care. The study was not designed to test statistically significant changes in patient outcomes. Only 64 patient records were reviewed. The disaster setting meant the number of approached families who refused or could not participate was not collected. Many patients could not take part because of illness severity, sensory loss, cognitive decline, or limited technology. Families outside the hospital sometimes found the communication software difficult, especially without stable internet. Emergency department staff still had to contact families for status updates and complete paper MOLST forms. Chaplaincy services were limited during the surge.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not read the proxy, code status, or hospice numbers as proof that remote nurse conversations alone improved care. The program also involved emergency department referral, provider communication, electronic record notes, and follow-up consults, and there was no comparison group.