Advance Care Planning Among Patients With Advanced Illness Presenting to the Emergency Department

Background: Advance care planning (ACP) benefits emergency department (ED) patients with advanced illness. Although Medicare implemented physician reim-bursement for ACP discussions in 2016, early studies found limited uptake. Objective: We conducted a pilot study to assess ACP documentation and billing to inform the develop-ment of ED-based interventions to increase ACP. Methods: We conducted a retrospective chart review to quantify the proportion of ED patients with advanced illness with Physi-cian Orders for Life-Sustaining Treatment (POLST) or cod-ing of ACP discussion in the medical record. We surveyed a subset of patients via phone to evaluate ACP participa-tion. Results: Of 186 patients included in the chart review, 68 (37%) had a POLST and none had ACP discussions billed. Of 50 patients surveyed, 18 (36%) recalled prior ACP discus-sions. Conclusions: Given the low uptake of ACP discussions in ED patients with advanced illness, the ED may be an un-derused setting for interventions to increase ACP discussions and documentation.(c) 2022 Published by Elsevier Inc.