TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records.

Objective: The aim of the study was to determine (1) whether do-not-resuscitate (DNR) orders created upon hospital admission or Physician Orders for Life-Sustaining Treatment (POLST) are consistent patient preferences for treatment and (2) patient/health care agent (HCA) awareness and agreement of these orders.

Methods: We identified patients with DNR and/or POLST orders after hospital admission from September 1, 2017, to September 30, 2018, documented demographics, relevant medical information, evaluated frailty, and interviewed the patient and when indicated the HCA.

Results: Of 114 eligible cases, 101 met inclusion criteria.

TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care.

Objective: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.

TRIAD VII: do prehospital providers understand Physician Orders for Life-Sustaining Treatment documents?

Background: Physician Orders for Life-Sustaining Treatment (POLST) documents are medical orders intended to honor patient choice in the hospital and prehospital settings. We hypothesized that prehospital personnel will find these forms confusing.

Objectives: The aim of this study was to determine whether POLST documents accord consensus in determining code status and treatment decisions among emergency medical services providers on the basis of an Internet survey.

TRIAD VI: how well do emergency physicians understand Physicians Orders for Life Sustaining Treatment (POLST) forms?

Background: Physician Orders for Life-Sustaining Treatment (POLST) documents are active medical orders to be followed with intention to bridge treatment across health care systems. We hypothesized that these forms can be confusing and jeopardize patient safety.

Objectives: The aim of this study was to determine whether POLST documents are confusing in the emergency department setting and how confusion impacts the provision or withholding of lifesaving interventions.

TRIAD IV: Nationwide Survey of Medical Students' Understanding of Living Wills and DNR Orders.

Introduction: Living wills are a form of advance directives that help to protect patient autonomy. They are frequently encountered in the conduct of medicine. Because of their impact on care, it is important to understand the adequacy of current medical school training in the preparation of physicians to interpret these directives.

TRIAD III: nationwide assessment of living wills and do not resuscitate orders.

Background: Concern exists that living wills are misinterpreted and may result in compromised patient safety.

Objective: To determine whether adding code status to a living will improves understanding and treatment decisions.

Methods: An Internet survey was conducted of General Surgery, and Family, Internal, and Emergency Medicine residencies between May and December 2009.

A living will misinterpreted as a DNR order: confusion compromises patient care.

Background: Advance directives are becoming ever more commonplace in the United States. Correct interpretation of living wills and do-not-resuscitate (DNR) orders is essential if patient safety and autonomy are to be preserved.

Objectives: 1) To recount a case in which a living will was misinterpreted as a DNR order; 2) To make known the ramifications of this misinterpretation; 3) To advocate for improved education of health care professionals regarding the interpretation and implementation of advance directives.

TRIAD II: do living wills have an impact on pre-hospital lifesaving care?

Background: Living wills accompany patients who present for emergent care. To the best of our knowledge, no studies assess pre-hospital provider interpretations of these instructions.

Objectives: Determine how a living will is interpreted and assess how interpretation impacts lifesaving care.

Does a living will equal a DNR? Are living wills compromising patient safety?

Living wills are thought to protect the medical decision-making capacity of patients. Presented are three case scenarios of patients with living wills presenting to health care facilities for treatment, and their hospital courses. Living wills have never been thought to compromise patient care or safety, but their use has not been adequately studied with respect to risks, benefits, or consequences.