Shared Medical Decision Making and Advance Care Planning using eMOLST in New York State

In the United States, approximately 20% patients die annually during a hospitalization with an intensive care unit (ICU) stay. Each year, critical care costs exceed $82 billion, which accounts for 13% of all inpatient hospital costs. Treatment of sepsis is listed as the most expensive condition in US hospitals at more than $20 billion annually. Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is an advance care planning tool used in New York State to convey patients’ wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments. The objective of our study was to investigate whether completion of an eMOLST form results in any reduction in length of stay and total direct costs within a community-based hospital in New York State. A cross-sectional retrospective chart review was conducted between July 2016 and December 2017. Primary outcome measures included length of hospital stay and total direct costs. Patients ≥65 years of age with a diagnosis of sepsis and an ICU stay were included in the study. Fisher’s Exact Tests and Regression Analyses were used to test for significant differences between those who had or had not completed the eMOLST form. Results: Completion of an eMOLST form was not associated with length of stay (p= 0.43) and not associated with total direct cost (p= 0.22). The time it took to complete the eMOLST form was associated with an increase in length of stay (p= \u3c0.001) and was associated with an increase total direct cost (p= \u3c0.001)