In a continuing line of research by Ferdinando Mirarchi (medical director of the Department of Emergency Medicine at the University of Pittsburgh Medical Center Hamot in Erie, PA).
In a survey of emergency physicians and pre-hospital providers, responders were given scenarios in which the patient had a POLST. The providers were then asked to decide what to do. Unfortunately, providers often know that the form exists but fail to read it, making assumptions about what it says. For example, DNR orders are equated with "do not treat" orders.
The outcomes of the study prompted the team to suggest that clinicians use a checklist built on the letters A, B, C, D, and E:
- A = Ask patients and surrogates to clarify their intentions about DNRs, POLST and other end-of-life planning documents.
- B = Be clear about the status of the patient, including terminal or critical illness “that can be treated.”
- C = Communicate with the patient about prognosis and expected outcomes.
- D = Design plans for care and review the steps in the plan.
- E = Explain about hospice and palliative care, and let patients know that treatment choices are up to them, and that their wishes will be honored.
The researches suggest that hospitals establish quality control procedures to ensure that end-of-life-care documents are prepared and interpreted accurately.