Increasing POLST completion in patients 65 and older: a primary care quality improvement proposal

Abstract

The Physician Order for Life Sustaining Treatment (POLST) is a signed medical order, relied on when an individual is unable to communicate, or unaccompanied by a healthcare proxy; POLST protects individuals with active preferences to waive default life support interventions (Turnbull et al., 2019). Adults aged 65 and older require more emergency services than any other demographic, yet only 20% of injured adults requiring emergency transport have a POLST at the time of 911 contact (Zive et al., 2019). 25% of patients aged 65 and older receiving primary care at a rural, western Montana clinic have a POLST in the electronic medical record (EMR). A literature review of POLST expansion into the non-acute care setting was conducted to create a clinic workflow for POLST completion. Eight primary care providers were issued a discussion framework and EMR documentation aid. Number of new POLST were captured from the EMR bi-weekly. Patients 65 and older presenting for an annual wellness visit (AWV) were screened for POLST in the EMR. Provider offered POLST completion for those without and documented discussion regardless of completion. Those not ready to complete POLST were sent home with the document and offered a 2 month follow up appointment to complete it. 10.8% of qualifying AWVs (n=37) during the 30-day study period resulted in POLST completion. Provider guided POLST discussion promotes patient centered care in the event of an emergency. A longer study period, built-in EMR reminders, and an on-site POLST leader may increase metric compliance.