title: Use of the Physician Orders for Life-Sustaining Treatment program for patients being discharged from the hospital to the nursing facility.
abstract: BACKGROUND
  The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients.
  
  
  OBJECTIVE
  The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions.
  
  
  METHODS
  Descriptive with chart abstraction and interviews.
  
  
  METHODS
  Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin.
  
  
  METHODS
  POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates.
  
  
  RESULTS
  Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often marked as based on a discussion with the patient and/or surrogate than when the form was used just for code status (95.1% versus 13.8%, p<.001). In the follow-up and interview sample, a majority (90.6%; 29/32) of POLST forms written in the hospital were unchanged up to three weeks after nursing facility admission. Most (71.9%; 23/32) appeared consistent with patient or surrogate recall of prior treatment decisions.
  
  
  CONCLUSIONS
  POLST forms generated in the hospital do transfer with patients across settings, but are often used only to document code status. POLST orders appeared largely consistent with prior treatment decisions. Further research is needed to assess the quality of POLST decisions.
authors.affiliation: 1 School of Nursing, Indiana University , Indianapolis, Indiana.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hickman
authors.forename: Christine A
authors.initials: CA
authors.lastname: Nelson
authors.forename: Esther
authors.initials: E
authors.lastname: Smith-Howell
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Hammes
mesh_terms: D032722:Advance Care Planning / Q000592:standards / Q000706:statistics & numerical data; D024362:Advance Directive Adherence / Q000706:statistics & numerical data*; D000368:Aged; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D057240:Patient Preference; D010865:Pilot Projects; D016414:Resuscitation Orders; D014922:Wisconsin