Objectives: To assess the percentage of adult patients presenting to an urban ED who have a written advance directive (AD) and to determine whether age, sex, a patient's perception of his or her health status, and having a regular physician are associated with the patient's having an AD. Methods: This was a cross-sectional patient survey performed at a community teaching hospital ED. Surveys were completed by 5 11 adult ED patients during representative shifts over a 3-month period. The questions included age, sex, "self-reported" health status, whether the patient had a "regular" physician, a patientgenerated list of medical problems, and whether the patient had a written AD. For this study, ADS included health care proxies, living wills, and do-not-attempt-resuscitation (DNAR) orders. Results: Of the patients surveyed, 27% reported having an AD. Males and females were equally likely to have an AD. Factors associated with an increased likelihood of having an AD were older age, having a "regular" physician, and the patient's perception of his or her health status as ill. Most patients who had an AD (82%) discussed it with their families, but only 48% discussed it with their physicians.
Conclusion:Only 27% of the adult patients presenting to the ED had an AD. Older age, the patient's perception of his or her health status as ill, and having a "regular" physician increased the likelihood of having an AD. Key words: advance directives; do not attempt resuscitation; legal; law; ethics; emergency department. care in the scenario of a deteriorating mental and physical state. When no formal documentation exists, it is often the emergency physician (EP) who is required to make difficult decisions with significant ramifications in a sometimes humed and underinformed fashion.One recent study evaluated the prevalence of ADS in ED patients who were elder or critically ill.' The purpose of our study was to determine the prevalence of ADS [health care proxies, do-not-attempt-resuscitation (DNAR) orders, living wills] in the adult ED population, as a whole, and how factors such as age, sex, and the patient's perception of health status are related to the likelihood of having an AD.