The rapid code status conversation guide for seriously ill older adults in acute respiratory failure
You are working a shift in your emergency department (ED) when an 85 year old female presents with a complaint of altered mental status. She comes from an extended care facility, where paramedics are able to tell you “they called us to come get her,”you are handed a stack of paperwork, given some vital signs, and you notice the patient is altered and unable to provide any further history. You dig a little in the paperwork and note a history of dementia as well as a long list of other medical problems, you notice no known advanced directive, and see that her daughter lives out of state but is available via phone. Have you been here? Seen this patient? If you have worked in emergency medicine long enough you certainly have. The tool outlined below is designed to help you know what to do in these difficult situations.
Heartbreaking patient situations are the backbone of Emergency Medicine. Whether it’s a new cancer diagnosis, telling a family member that their loved one has died, or the creeping dread that a mistake that we’ve made will negatively impact one of our patients, we all experience extraordinary stress in our day-to-day clinical practice. Most clinicians are not tasked with routinely sharing news about the violent, unexpected, and horrific life-changing situations that occur in the emergency department, and yet we are given so few tools to help us manage this firehose of grief. This article is intended to share some of the best practices of grief management with clinicians who are immersed in grief, even if unawares.
Over 1,300 physicians across the U.S. were asked to interpret patient preferences for end-of-life care in theoretical cases. Physicians rarely reached consensus about patient preferences when they were given only living wills and POLST documents to interpret. The addition of a patient video testimonial helped physicians make better care decisions that reflected their patients’ wishes. Will video become the new national standard for advance care planning?