Table 3.
Categorization of treatment rationales as primarily comfort focused or potentially life-prolonging by treatment order.1
| POLST Order |
Treatment | Rationale | Primarily Comfort- Enhancing |
Primarily Life- Prolonging |
Consistent with order? |
Overall Consistency with Order by Section |
|---|---|---|---|---|---|---|
| Section B: Comfort Care Only (n = 300) |
ED/Hospitalization | Trauma related to fall | 13 | Yes | 74.3% (26/35) |
|
| ED/Hospitalization | Uncontrolled pain/pain evaluation | 4 | Yes | |||
| ED/Hospitalization | Gastrointestinal bleed | 3 | Yes | |||
| ED/Hospitalization | Significant bleeding | 2 | Yes | |||
| ED/Hospitalization | Chronic Heart Failure/pulmonary edema | 2 | Yes | |||
| ED/Hospitalization | Gastrointestinal bowel obstruction | 1 | Yes | |||
| ED/Hospitalization | Wound infection/care | 1 | Yes | |||
| ED/Hospitalization | Upper Respiratory Infection | 4 | No | |||
| ED/Hospitalization | Pneumonia | 2 | No | |||
| ED/Hospitalization | Altered level of consciousness | 1 | No | |||
| ED/Hospitalization | Cerebrovascular accident | 1 | No | |||
| Intravenous Fluids | electrolyte imbalance | 1 | No | |||
| Section B: Limited Additional Interventions2 (n = 300) |
ED/Hospitalization | Pneumonia | 8 | Yes | 98.3% (57/58) |
|
| ED/Hospitalization | Trauma related to fall | 8 | Yes | |||
| ED/Hospitalization | Altered level of consciousness | 7 | Yes | |||
| Intravenous Fluids | Dehydration | 6 | Yes | |||
| ED/Hospitalization | Uncontrolled pain/pain evaluation | 5 | Yes | |||
| ED/Hospitalization | Upper Respiratory Infection | 5 | Yes | |||
| ED/Hospitalization | Significant bleeding | 4 | Yes | |||
| ED/Hospitalization | Chronic Heart Failure/Pulmonary edema | 3 | Yes | |||
| ED/Hospitalization | Hypoglycemia | 2 | Yes | |||
| ED/Hospitalization | Amputation - foot/leg | 1 | Yes | |||
| ED/Hospitalization | Wound infection/care | 1 | Yes | |||
| ED/Hospitalization | GI bleed | 1 | Yes | |||
| ED/Hospitalization | GI bowel obstruction | 1 | Yes | |||
| ED/Hospitalization | Renal Calculi | 1 | Yes | |||
| Dialysis | Renal failure | 1 | Yes | |||
| Intravenous Fluids | medication administration | 1 | Yes | |||
| ED/Hospitalization | Hypertension | 1 | Yes | |||
| ED/Hospitalization | Cerebrovascular Accident | 1 | Yes | |||
| ICU Admission | Pneumonia | 1 | No | |||
| Section C: No Antibiotics (n = 28) |
Antibiotics | Urinary Tract Infection | 4 | No | 0% (0/7) |
|
| Antibiotics | Upper Respiratory Infection | 1 | No | |||
| Antibiotics | Skin/Wound infection | 1 | No | |||
| Antibiotics | No reason provided§ | – | – | No | ||
| Section C: Limited Antibiotics3 (n = 227) |
Antibiotics | Urinary Tract Infection | 39 | Yes | 83.3% (50/60) |
|
| Antibiotics | Skin/Wound Infection | 7 | Yes | |||
| Antibiotics | Eye infection | 1 | Yes | |||
| Antibiotics | Clostridium-difficile infection | 1 | Yes | |||
| Antibiotics | Stomach Ulcers | 1 | Yes | |||
| Antibiotics | Oral infection | 1 | Yes | |||
| Antibiotics | Pneumonia | 7 | No | |||
| Antibiotics | Upper Respiratory Infection | 3 | No |
Note: ED/Hospitalization = Emergency Department visit with our without hospitalization.
1
Categorization of treatment rationales as primarily comfort-focused or primarily life-prolonging was determined using Treatment Decision Rules developed by the research team.
2
Section B orders for limited additional interventions allows for treatments to enhance comfort and to prolong life within certain limitations.
3
Section C orders for limited antibiotics include exceptions allowing for the use of antibiotics to enhance comfort only.
§
n = 1