ABSTRACT
Background: Coronavirus Disease 2019 (COVID-19) has heightened the importance of emergency department (ED) providers in initiating advance care planning (ACP) conversations. Clarifying ACP helps ensure care is aligned with patients' wishes and can avoid unnecessary suffering. The objective was to determine the effect of a training for emergency providers on ACP conversations in the ED during the COVID-19 pandemic. We hypothesized that the intervention would increase the documentation of advance care planning in the emergency department. Methods: This was an observational pre-/post-interventional study at a southeastern academic emergency department. Palliative care physicians carried out a three-fold educational intervention for emergency medicine providers on April 1, 2020 including: (1) an evidence-based guide to COVID-19 risk stratification, (2) education on language to initiate ACP conversations, and (3) instructions on how to document ACP preferences in the electronic health record. A medical student was trained on manual chart review of COVID-infected patients. Data was then abstracted on patient demographics, placement of code status orders, documentation of a healthcare decision maker (HCDM), and documentation of ACP. Results: In total, 143 charts of confirmed COVID-19 patients were reviewed between March 26, 2020 and May 25, 2020. There were 28 patients in the pre-intervention period and 115 post-intervention. There was a roughly ∼25% increase in ACP-related activities among emergency providers in the post-intervention period (25.0% v 49.6% ACP activities noted in the pre-and post-intervention subjects, respectively ;p < 0.03). After adjustment for patient demographics, a non-significant trend towards increased ACP activity was observed (OR = 2.54, p = 0.08). Conclusion: We present preliminary evidence that a simple physician-facing educational intervention can improve ED-based goals of care conversation and documentation for patients infected with COVID-19.