Registration Attendants Show Poor Readiness to Handle Advanced Care Planning Discussions.

Area of Science:

• Medical Ethics
• Healthcare Administration
• Emergency Medicine

Background:

• Hospitals are mandated to provide advance directive (AD) information to patients in emergency departments (EDs).
• Staff comfort and preparedness for discussing ADs in the ED setting remain unclear.
• Advance care planning (ACP) is a crucial component of patient-centered care.

Purpose of the Study:

• To assess the attitudes, comfort levels, and prior training of ED staff regarding advance directives (ADs).
• To identify variations in preparedness and engagement with ACP discussions among different ED professional roles.
• To inform targeted training initiatives for ED staff involved in advance care planning.

Main Methods:

• A survey was administered to ED social workers, nurses, registration attendants, residents, and attending physicians at two academic hospitals.
• The survey collected data on staff attitudes, preparedness, and experiences with ACP discussions.
• Data from 220 ED staff responses were analyzed to determine trends by profession.

Main Results:

• Preparedness for ACP discussions varied significantly by profession; social workers (80%) and attending physicians (52%) reported higher preparedness than registration attendants (4%).
• Attending physicians (77%) and social workers were most likely to initiate ACP discussions, while registration attendants were least likely (8%).
• While 59% of staff believed ACP is part of emergency care, only 13% had received specific training.

Conclusions:

• ED staff generally support the integration of ACP into emergency care.
• Significant disparities exist in staff preparedness and engagement with ACP, necessitating profession-specific training.
• Registration attendants, often tasked with AD inquiries, require enhanced training to confidently discuss these sensitive matters.