12. Listen to the Patient
Involve the emergency room, hospice or home health providers to make sure patients don't come to the emergency room for non-emergent end-of-life care issues. Providing patients and their family members with informed choices, opportunities for advance directives, and counseling in the emergency room setting may avert painful, unnecessary admissions. Look for this to be a major expansion of palliative care professionals inside the ED.
"There really needs to be a care plan that reflects the patient's wishes," Jencks says. "This is quite different from either a medical power of attorney or what is often called a living will because it lays out the goals of treatment.
"Cure? Palliation? Functional independence? Playing dominoes with friends? Hospice? This kind of plan has little relevance to persons without substantial chronic conditions, but it is totally relevant to a patient with one or more chronic conditions that have required hospitalization. With such a plan, one can often avoid readmissions that really do not serve the patient’s needs or values. What is, after all, worse than a readmission? Readmission of a patient who does not want to be readmitted," Jencks says.
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