Say you’re a seemingly healthy 50-year-old and you suddenly collapse on a golf course.
Or you’re an 87-year-old who suffers a stroke and wakes up unable to speak.
Would your family members know what — and how much — medical care you would want, in an emergency situation or during the course of an illness? Would they know what to tell an emergency medical technician, an emergency room doctor or a caregiver at a nursing home?
A new initiative aims to help individuals spell out their wishes ahead of time, to make following them easier for families and health care providers and to help ensure that patients retain their voice throughout.
Over the next three months, doctors from six Nebraska health care groups will pilot a new, standard emergency medical planning form at three Omaha-area doctors’ offices.
The Nebraska Emergency Treatment Order, developed over the past year with input from about 200 people from all along the health care continuum, including doctors and lawyers, provides a standard set of directions that can be used by emergency responders, hospitals, rehabilitation facilities and nursing homes.
The health care groups are announcing the initiative in conjunction with National Health Care Decisions Day, which this year has been extended to a week that runs through Saturday. The aim is to help people across the United States understand the value of advance health care planning.
Dr. Lou Lukas, a family and palliative medicine physician with Methodist Health System, said the document is intended to be clear enough that health care providers can take action in a medical emergency but still allow for adjustments, knowing that no one can predict all of the situations they might face.
“If you show up in the emergency room with this, they know what to do,” Lukas said. “It’s a very actionable form that translates into, ‘What do you want the health care system to do for you?’ ”
It includes four basic sections intended to guide decision-making from the start of emergency treatment through end-of-life care, moving from the least to the greatest amount of intervention and covering key points along the way, such as CPR, surgery, life support, intensive care and long-term nutrition.
The document also includes a section for physician’s orders for emergency responders indicating the patient’s status regarding resuscitation, intubation and transportation that would be signed by the patient and a doctor or nurse practitioner.
“If you make a couple of key decisions,” Lukas said, “you can lighten the load for everyone down the line, and you stand a better chance of getting the care you want.”
As age, situation and health status change, she said, a person could talk with a doctor and family members and write a new form. A healthy 50-year-old, for example, may want different interventions than an ailing 90-year-old.
Jacob Dahlke, a clinical ethicist at Nebraska Medicine, compared the concept to family members adjusting their emergency plans if they move from California, where earthquakes are a risk, to tornado-prone Nebraska.
“We talked about this being a living, breathing document that’s going to change over time,” he said.
Lukas and Dahlke said the other goal is to change the culture around how people talk about emergency health care and give people a common language with which to discuss it.
“It’s easier to have that conversation if we all have the same words,” Dahlke said.
After piloting the program at three practices, organizers would tweak the program if necessary and then distribute it to additional practices in the health care groups, known as Accountable Care Organizations. The six ACOs participating in the initiative represent more than 4,000 Omaha-area doctors.
They are the Midwest Independent Physicians Practice Association, Nebraska Health Network, OneHealth Nebraska, South East Rural Physicians Alliance, Think Healthcare and UniNet.
Eventually, Lukas said, plans call for rolling it out to others, even taking it statewide.
Goal of new initiative is to encourage advance health care planning | Health