Clackamas County Launches DNR Helpline

When EMS responds to a scene for an elderly or terminally ill patient, they may not have much time to look for a DNR or other end-of-life-wishes document. Thanks to forward-thinking individuals in Oregon, that problem has been addressed with a 24-hour hotline where medical personnel can obtain information about their patients' healthcare wishes.

The Physician Orders for Life-Sustaining Treatment (POLST) program was conceived in 1991 by a group of Oregon healthcare professionals who identified the need for a system to ensure that elderly patients and those with advanced illness have medical orders on file to direct their healthcare and ensure their end-of-life wishes are followed. This is accomplished with a double-sided medical order form filled out by patients and their healthcare providers explaining what types of treatment they want if they become incapacitated.

"One of the things we learned from a research study, as well as talking to EMTs and paramedics, is that, while the POLST documents are incredibly helpful to EMS, maybe as often as 25% of the time, they can't find the form when they first arrive at the scene," says Terri Schmidt, MD, professor of emergency medicine at Oregon Health & Science University (OHSU) School of Medicine and director of the registry project. "The recommendation from several sources was to develop a 24/7, real-time electronic access to the forms, and that's what we're moving towards."

The program, which went into effect on May 26 in Clackamas County, allows on-scene medics to call the POLST hotline based at OHSU to inquire about the existence of a POLST form and ask pointed questions that ensure the patient and form are an exact match. At the time of this writing, there was legislation under discussion at the state level to make it a statewide registry, perhaps as early as fall. "If the legislation passes, it will be a state-sponsored registry through the Department of Human Services, and they will contract with OHSU to house and manage it," Schmidt explains. "If approved, it will mandate that all completed forms be sent to the registry, unless the patient specifically opts out. Our goal is to submit forms within 24--48 hours to be entered into the database. As patients approach the final phases of life, there may be changes, and we'll update the forms whenever that happens."

For more information, go to www.ohsu.edu.