Ishihara K K, Wrenn K, Wright S W, Socha C M, Cross M
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Acad Emerg Med. 1996 Jan;3(1):50-3. doi: 10.1111/j.1553-2712.1996.tb03303.x.
To determine: 1) the number of patients arriving at the ED who had executed an advance directive (AD), 2) how many of the patients who had an AD brought the AD with them, and 3) whether those patients who did not have an AD had ever discussed ADs with their primary care providers (PCPs) or had ever heard of an AD.
A cross-sectional, observational survey of a convenience sample of high-risk patients presenting to the ED of a university hospital was performed. Patients presenting to the ED for acute complaints who were elderly or had an underlying disease that suggested a risk of death in the near future were considered high risk.
Of the 238 patients surveyed, 90% had PCPs. However, only 22% had ADs. Of these, only 23% brought the AD to the ED. Of the patients who did not have ADs, 95% had never discussed ADs with their PCPs, and 42% did not know what an AD was. Blacks were less likely than whites to have ADs (p < 0.0002) or to know about them (p < 0.004).
The majority of high-risk patients presenting to this ED do not have ADs. Among those high-risk patients who did have ADs, fewer than 25% brought the ADs with them. The development of ADs for high-risk patients and the availability of ADs in the ED are woefully inadequate. Emergency physicians need to collaborate with PCPs to remedy these deficiencies.
确定：1）到达急诊科且已签署预立医疗指示（AD）的患者数量；2）有预立医疗指示的患者中有多少人随身携带了该指示；3）没有预立医疗指示的患者是否曾与他们的初级保健医生（PCP）讨论过预立医疗指示，或者是否听说过预立医疗指示。
对一家大学医院急诊科的高危患者便利样本进行横断面观察性调查。因急性病症前往急诊科就诊的老年患者或患有提示近期有死亡风险的基础疾病的患者被视为高危患者。
在接受调查的238名患者中，90%有初级保健医生。然而，只有22%有预立医疗指示。其中，只有23%的人将预立医疗指示带到了急诊科。在没有预立医疗指示的患者中，95%从未与他们的初级保健医生讨论过预立医疗指示，42%不知道预立医疗指示是什么。黑人比白人拥有预立医疗指示（p < 0.0002）或知晓预立医疗指示（p < 0.004）的可能性更低。
前往该急诊科就诊 的大多数高危患者没有预立医疗指示。在那些确实有预立医疗指示的高危患者中，不到25%的人随身携带了预立医疗指示。针对高危患者的预立医疗指示的制定以及急诊科中预立医疗指示的可获取性严重不足。急诊医生需要与初级保健医生合作以弥补这些不足。
