Abstract
Purpose: The purpose of this quality improvement project was to develop and implement a standardized protocol to educate adult patients admitted to a Midwestern hospital Trauma Intensive Care Unit (TICU) regarding the importance of selecting a formal surrogate decision maker (SDM) and evaluate whether there was an increase in the completion rates.|Background: Many patients present to the hospital after a traumatic accident without previously selecting a SDM to advocate for them. The rapid growth of the elderly population, the multitude of barriers preventing the selection of a surrogate, and the continued low Advance Directive completion rates revealed the need to educate patients.|Sample/Setting: The setting was the TICU at CHI Health Creighton University Medical Center Bergan Mercy (CUMC-BM) in Omaha, Nebraska. The sample included adult patients without a SDM in place, competency to make their own decisions and under the primary care of the Trauma Team.|Methods: This was a quality improvement project that developed and implemented a standardized protocol to educate trauma patients about the importance of selecting a formal SDM. The effectiveness of this standardized protocol was evaluated by following up with the participants via a phone call four weeks after the education occurred.|Results: Among the 71 potential participants identified, 46 (65%) met criteria to be approached regarding participation. Of these potential participants, 16 (35%) reported already having a formal SDM in place. 27 patients consented to participating in the education and follow up phone call, and 19 were reached. Out of these 19, 74% indicated they had identified a formal SDM, 47% completed an Advance Directive document, and 11% submitted those documents to the EMR.|Conclusions: Advance Directive completion rates continue to be low. There is a need for increased utilization of a standardized protocol to educate patients regarding the importance of selecting a formal SDM, as this has shown to be an effective approach of increasing completion rates. Further research utilizing trauma patients as the target population as well as research focusing solely on the important role of the SDM specifically is necessary.|Keywords: surrogate, decision maker, advance, directives, trauma, barriers, education, communication