Date

6-2015

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health & Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Traumatic injuries among older (≥65 years) adults are increasing annually in the United States. There is a growing need for decision-making tools that guide acute interventions based on patient preferences, particularly when the patient may not be able to participate in their own care. The Physician Orders for Life-Sustaining Treatment (POLST) program was created in an effort to help people, especially older adults, direct their care in the event of an emergency. Multiple studies have found to the POLST program to be effective in nursing homes, hospices and in out of hospital cardiac arrest field decision-making. However, to date, no studies have examined the role of the POLST program in the setting of traumatic injuries.

Methods & Results: This is a multi-method study involving retrospective data from the OHSU Trauma Registry and individual chart review for patients ≥65 years arriving at OHSU for trauma care from March 2007 – December 2013 (n=1622). 180 patients (11.1%) were found to have a POLST form on file upon arrival. Patients with a POLST form were less likely to be intubated (p=0.011) during their hospital stay and had significantly different ED dispositions (p=0.023) than those without a POLST form. POLST patients who had selected “Comfort Measures” or “Limited Interventions” had significantly shorter total hospital and ICU length of stays (p=0.0098 and p=0.0242, respectively) compared to those patients who had selected “Full Treatment”. Chart review of those patients with a POLST on file revealed ways in which care providers are using the POLST form in their medical decision-making for complex trauma patients.

Conclusions: The POLST form is a useful decision-making tool in the setting of traumatic injuries that allows for a variety of patient preferences to be met, particularly related to ED disposition, intubation and diagnostic work-up. This study adds to the growing body of evidence supporting the utility of the POLST form in a multitude of medical environments, however, further research is needed to better understand the way in which health care providers and patients understand and interpret the POLST form, particularly in emergency situations.

Identifier

doi:10.6083/M4HM575Q

School

School of Medicine

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