The new Oregon Physician Orders for Life-Sustaining Treatment (POLST) Registry, which is operated by the OHSU Department of Emergency Medicine through a contract from the state of Oregon, went "live" statewide Dec. 3, 2009. Nicholas_Weltch_6Although having a POLST form is voluntary, state regulations now mandate that a health care professional who signs a POLST form send it to the new Registry unless the patient opts out. So far, about 20,000 Oregonians have made their information available to Emergency Medical Services (EMS) providers and physicians.

"This is a good outcome," said Terri Schmidt, MD, Professor, Department of Emergency Medicine, and Director, Oregon POLST Registry. "In my decades as an emergency medicine physician, I know how quickly an unexpected event can become a medical tragedy for someone with a long-standing illness. The Registry is a tool that ensures professionals have rapid access to a patient's wishes."

The original bright pink POLST document remains the primary method of indicating one's preferences for emergency care. At OHSU, a copy is included in a patient's electronic health record (EHR), but not all systems and providers use an EHR, or the same EHR. Furthermore, the paper POLST form frequently is not immediately available to EMS personnel in a time of crisis. Now, copies of POLST forms are entered into a secure electronic database (the Registry) that allows EMS responders to call a phone number and – within about 80 seconds – determine whether the patient has a POLST form on record.

"The POLST Program came about as a way of ensuring that people with advanced illness or frailty receive the treatments they want and avoid those they do not want," said Susan Tolle, MD, Cornelia Hayes Stevens Chair, Professor, Department of Medicine, and Director, OHSU Center for Ethics in Health Care. "The Registry provides a backup system for quickly relaying a patient's wishes as medical orders to the health care professionals who need it, when they need it."

As of May 31, there are 17,626 active, searchable forms; 2,040 archived forms; and 2,437 forms that are not Registry-ready, meaning there is missing or illegible information. Steps to further enhance the POLST Registry will be taken later this summer, when Dr. Schmidt and her colleagues begin contacting EMS providers and patients or the patients' family members who have used the Registry to get feedback on their experience.

OHSU's Center for Ethics provides education about POLST to patients and health care professionals, and has distributed over one million forms in Oregon since 1995. However, there has been no way to track the number of completed forms nor has there been a centralized repository for them. Now, the Registry provides an unprecedented opportunity for leaders of the program. "For the first time, we will know how many POLST forms are out there," said Dr. Schmidt. "We'll know what choices Oregonians are making."

The POLST hotline for EMS is staffed 24/7 by the OHSU Emergency Communication Center in the Department of Emergency Medicine. The Registry has received a total of 151 calls, with a match rate of about 14 percent. Dr. Schmidt said she expects the match rate to increase as the Registry receives more entries.

Thirty-three states have either implemented or are developing a POLST program similar to the model pioneered in Oregon. "The POLST program, developed at the Center for Ethics at OHSU, is a model for the nation," said Dean Richardson. "It allows individuals to make choices about care they receive in advance of an emergency, when those decisions can be carefully and completely thought through."

Pictured: Nicholas Weltch, Emergency Transport Coordinator, responds to calls, including inquiries about patients in the POLST Registry, in OHSU's Emergency Communication Center.