[Pre-operative documentation of individual in-patient therapy goals : A medical staff questionnaire].
BACKGROUND
Perioperative care demands consideration of individual treatment goals. We evaluated the attitudes of medical staff towards a short standardized advance directive (SSAD) as a means of improving patient-orientated care at the transition from operating theater to general or intensive care wards.


METHODS
Multicenter anonymized standardized multiple-choice questionnaire among physicians and nurses from various operative and anesthesiology departments. Questions addressing demographic parameters and attitudes towards advance directives in acute care settings (eleven 4‑stepped Likert items). Univariate analysis of group comparisons using the chi-square and Kruskal-Wallis rank-sum test. Multivariable analysis of significant differences employing ordinal logistic regression.


RESULTS
The overall return rate was 28.2 % (169 questionnaires). Of these, 19.5 % said that existing advance directives were regularly reassessed preoperatively. SSAD was expected to provide improved emergency care by 82.3 and 76.6 % thought that it would help to better focus intensive care resources according to patients' needs.


CONCLUSIONS
Our study shows the dilemma of insufficiently structured directives for changing treatment goals as well as a high number of legal procedures to obtain proxy decisions due to missing out-patient advance health planning. From a medical staff perspective there is strong support for the concept of SSAD based on medical, ethical, economic and organizational reasons.
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany. katrin.umgelter@lrz.tum.de.
K
K
Umgelter
Klinik für Neurochirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, München, Germany.
J
J
Landscheidt
Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabing, Städtisches Klinikum München GmbH 1, München, Germany.
K
K
Jäger
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany.
M
M
Blobner
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany.
E
E
Kochs
D000328:Adult; D024362:Advance Directive Adherence; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000941:ethics / Q000592:standards; D004282:Documentation; D005260:Female; D006040:Goals; D006801:Humans; D007297:Inpatients; D008297:Male; D008503:Medical Staff; D008875:Middle Aged; D005791:Patient Care / Q000592:standards*; D010564:Personnel, Hospital; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires
Critically ill; Intensive care; Medical staff; Perioperative care; Short standardized advance directive (SSAD)