Dekker NRP*, Sabine Netters FJ, Roijen IFH, Hasker A, van de Wetering JK, Waanders F, Fiebrich FBH, Morariu A, de Groot BJW and Vissers CPK
Department of Emergency, Hospital in Zwolle, The NetherlandsFulltext PDF
Objectives: During the Coronavirus 2019 pandemic (COVID-19), the pressure on hospital capacity and the Intensive Care Unit (ICU) increased dramatically. Advance Care Planning (ACP) with patients is of utmost importance. The aim of this study was to examine whether a remote independent Advance Care Directives (ACD) advice could support treating physicians in ACP. Methods: In this single center prospective observational study, we included 167 patients with a COVID-19 infection on the internal medicine ward between 17th March and 17th April 2020. An ACD committee of medical specialists, not directly involved in the care of these patients, formulated a remote independent ACD advice to the treating physicians concerning escalation of care. Follow up for survival was evaluated after 6 months. The treating physicians completed an online survey concerning the value of the remote independent ACP advice. Results: In 149 out of the 167 cases (89.2%) the advice of the ACD committee matched the decision of the treating physician. A negative ACD advice for mechanical ventilation has been overruled in three patients. These three patients died despite escalation to mechanical ventilation on the ICU. Of the treating physicians, 95.6% confirmed benefit of the advice. Conclusion: Independent remote ACD advice during the COVID-19 pandemic could offer valuable help in the decision making process whether to escalate to life-sustaining critical care for treating physicians and patients.
Dekker NRP, Sabine Netters FJ, Roijen IFH, Hasker A, van de Wetering JK, Waanders F, et al. Hospital based Remote Advance Care Directives Advice during the COVID-19 Pandemic: A Prospective Study. Int J Intern Emerg Med. 2021; 4(2): 1045.