Abstract | November 6, 2020

Assessing the Barriers & Benefits Associated with Using Psychiatric Advance Directives to Guide Care within the Emergency Department

Presenting Author: Courtney Kathleen Rich, M.B., B.Ch., B.A.O., M.P.H., Emergency Medicine Resident PGY1, Department of Emergency Medicine, Magnolia Regional Health Center, Corinth, Mississippi

Co-Author: Dr. Marisa Domino, PhD, Professor, Health Policy & Management, UNC Gillings School of Global Public Health, Chapel Hill, NC

Learning Objectives

  1. Examine the function of psychiatric advance directives in clinical medicine.
  2. Examine the potential for psychiatric advance directives to improve psychiatric care within the emergency department if certain barriers can be addressed appropriately.

Background: While psychiatric advance directives (PADs) have been used within the field of mental health for a number of years and have been proven to reduce the need for coercive intervention, increase post discharge treatment adherence, and improve medication compliance, they remain an underused and under-investigated tool in patient care. In the field of emergency medicine, a discipline which has a high level of interaction with psychiatric patients, little to no literature is available concerning the use of PADs to guide clinical psychiatric care within the emergency department (ED). This study sought to examine some of the potential benefits and barriers were PADs to be utilized within emergency medicine.

Methods: These were elicited via key informant interviews with emergency medicine physicians working within the University of North Carolina healthcare system and through a substantive review of available literature regarding the use of PADs in the field of psychiatry. At total of 5 interviews were performed between the dates of May 1st, 2019 and July 31st, 2019. Feedback provided by participants was analyzed and organized into themes in order to compile a list of benefits and barriers identified.

Results: Benefits elicited included – preservation of patient autonomy and self-determination, improved patient buy-in, and increases in efficacy of treatment. Barriers fell into three major categories – patient factors, proxy factors, and document factors. Additionally, a confounding factor to all three of these is the time and desire of the treating emergency provider to pursue the identification and use of a PAD.

Implications: Solutions to the most commonly cited concerns by participants are proposed and discussed in this study. These include promotion of facilitated PAD completion sessions and creating an accessible and clearly labeled location within electronic health records (EHRs) for PADs to be filed.

Posted in: Emergency & Disaster Medicine9 Psychiatry2