End-of-life Care Wishes can be Overlooked if Forms Can't be Found in a Crisis
PORTLAND, Oregon – OHSU has taken a new step in making sure that end-of-life care wishes for OHSU patients are honored, creating a new feature where health professionals can electronically find any Physician Orders for Life-Sustaining Treatment, or POLST, form in the Oregon POLST registry, regardless of where it was received.
"POLST forms allow patients to work with their health care team to thoughtfully document the medical orders for the care they wish to receive when nearing the end of life,” says Susan Tolle, M.D., director of the Center for Ethics in Health Care at OHSU and professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. "But POLST forms only work if health care professionals can find these orders quickly, particularly in emergency situations.”
Currently emergency health care professionals must call the statewide POLST registry to access forms that were not filed within their health system. For example, OHSU clinicians could easily view the 15,000 POLST forms in the OHSU record system, but could not view forms completed elsewhere. Now OHSU can quickly find any form the patient has of the 160,000 forms in the statewide POLST registry with the click of a button, and without leaving the patient's record.
Oregonians like 95-year-old Betty Lou Hutchens see this development as an important step in making sure their end-of-life care wishes are honored.
"I think it's very important to be able to find the POLST form,” says Hutchens. "After all, what good is it if you can't find it. That must be in place for the whole system to work.”
In 2015, OHSU partnered with San Francisco-based tech start-up Vynca to automate the process for filling out and finding POLST forms by creating an online system for submitting forms and digitizing paper forms.
"It's so very important to have a POLST form from available because it not only gives you peace of mind but also the family peace of mind so we know exactly what the patient wants…what I want,” Hutchens says. "It was very wonderful when I went through this with my husband to be able to have that all in place. We didn't have a thing to worry about. The doctors didn't because it was all written out and they could find it.”
Vynca, the technology vendor used by OHSU has also worked with Samaritan Health Services to digitize their POLST system and they will be launching statewide access to the registry that OHSU just launched in the coming months.
"Our mission is to ensure that every patient receives the care they want at the end of life, and this technology represents a considerable advancement toward achieving this goal,” says Ryan Van Wert, M.D., chief medical officer of Vynca and part-time clinical assistant professor of medicine in pulmonary and critical care medicine at Stanford University.
The POLST form was created in 1990 by a group of ethics leaders convened by OHSU 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 47 states and they are strongly associated with reducing unwanted hospitalizations near the end of life.
A survey of patients showed that less than 10 percent of patients want to die in the hospital. Unfortunately, without POLST form, four times that many still do.
Oregon Health & Science University is a nationally prominent research university and Oregon's only public academic health center. It serves patients throughout the region with a Level 1 trauma center and nationally recognized Doernbecher Children's Hospital. OHSU operates dental, medical, nursing and pharmacy schools that rank high both in research funding and in meeting the university's social mission. OHSU's Knight Cancer Institute helped pioneer personalized medicine through a discovery that identified how to shut down cells that enable cancer to grow without harming healthy ones. OHSU Brain Institute scientists are nationally recognized for discoveries that have led to a better understanding of Alzheimer's disease and new treatments for Parkinson's disease, multiple sclerosis and stroke. OHSU's Casey Eye Institute is a global leader in ophthalmic imaging, and in clinical trials related to eye disease. OHSU Center for Ethics in Health Care is dedicated to raising the level of ethical standards in all aspects of health care throughout the community.