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Titolo:
Advance directives in skilled nursing facility residents transferred to emergency departments
Autore:
Lahn, M; Friedman, B; Bijur, P; Haughey, M; Gallagher, EJ;
Indirizzi:
Albert Einstein Coll Med, Dept Emergency Med, Bronx, NY 10467 USA Albert Einstein Coll Med Bronx NY USA 10467 ency Med, Bronx, NY 10467 USA
Titolo Testata:
ACADEMIC EMERGENCY MEDICINE
fascicolo: 12, volume: 8, anno: 2001,
pagine: 1158 - 1162
SICI:
1069-6563(200112)8:12<1158:ADISNF>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
SELF-DETERMINATION ACT; IMPLEMENTATION;
Keywords:
advance directives; nursing homes; resuscitation orders; living wills; emergency treatment; cardiopulmonary resuscitation;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
6
Recensione:
Indirizzi per estratti:
Indirizzo: Gallagher, EJ Montefiore Med Ctr, Dept Emergency Med, 111 E 210th St, Bronx, NY 10467 USA Montefiore Med Ctr 111 E 210th St Bronx NY USA 10467 467 USA
Citazione:
M. Lahn et al., "Advance directives in skilled nursing facility residents transferred to emergency departments", ACAD EM MED, 8(12), 2001, pp. 1158-1162

Abstract

Objective: Ten years have passed since Congress enacted the Patient Self-Determination Act to promote the use of advance directives (ADs). This studywas performed to determine the frequency, type, demographic distribution, and utility of ADs that accompany residents of skilled nursing facilities (SNFs) transferred to emergency departments (EDs). Methods: This was an observational, cross-sectional cohort of SNF residents, transferred to two urban, academic EDs. Chart review and physician interviews were conducted on consecutive patients arriving during 12-hour data collection shifts. Results:Among 715 patients entered, 315 [44%, 95% confidence interval (95% CI) = 40% to 48%] had an AD. Advance directives were significantly more prevalent among white (50%) than African American (34%) or Hispanic (39%) patients (p< 0.001), and varied from 0% to 94% among SNFs. Of the 315 patients with ADs, do-not-resuscitate (DNR) orders were the most prevalent (65%, 95% CI = 58% to 69%). Although 75% (95% Cl = 69% to 81%) of the DNR orders addressedcardiopulmonary resuscitation (CPR), only 12% (95% Cl = 8% to 16%) addressed intubation. Among 39 patients who required intubation or CPR, 44% had ADs, 82% (95% CI = 57% to 96%) of which were deemed useful. Conclusions: Despite a decade of legislation promoting their use, ADs are lacking in most SN-F residents transferred to EDs for evaluation and in most settings in which a clinical indication exists for intubation or CPR. Variation in their prevalence appears to be associated with both ethnicity and SNF origin. Although about three-fourths of DNR ADs addressed CPR, only about one in ten offered guidance regarding intubation. When available, ADs are used in most instances to guide emergency care.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 09:00:53