Validating Medical Treatment Decision Makers in the Medical Records of a Teaching Hospital

Abstract Background A Medical Treatment Decision Maker (MTDM) is appointed to make medical treatment decision on behalf of a person who cannot make such decisions for themselves, provided they are reasonably available and willing to make such decisions. In the Emergency Department (ED), the clinicians’ ability to contact MTDMs is an essential for patient care, particularly in time-critical situations or when end of life discussion is necessary. Our primary objective was to review the verification process and assess the accuracy of MTDM contact numbers in the Health Information System (HIS) at our institution. Methods Quantitative method with retrospective observational study design with phone interview transcript was used. Data was imported from Microsoft Office Excel Spreadsheet to SPSS™ for analysis and statistical significance indicated by a two-sided P value < 0.05 and Confidence Interval (CI) range. Results Of the one hundred and sixty-nine patients selected, seventy six percent had a MTDM listed selected of whom 59% were available for follow up. The process of registering and validating a person as a MTDM in the HIS was found to be compliant with legal requirements. There was no reported, observed or known existing contact update alert process in the HIS after a period of patient record inactivity. Patient advancing age had statistically significant association with the number of call attempts made to reach the listed MTDM (P = 0.043; CI, -3.541 to -0.057) and the MTDM’s consent to participate (p = 0.023). Patient gender had statistically significant association with successfully contacting the listed MTDM (p = 0.036; CI, 0.012 to 0.355) and the number of call attempts made to reach the listed MTDM (P = 0.039; CI, 0.006 to 0.218). Conclusion Identification and listing of MTDMs for elderly patients need to improve, as the study found only 76% had MTDMs listed. In our sample only 59% responded to a contact call, a concerning result when considering the possible time critical nature of such a call. Four participants declined to consent as a call originating from a hospital extension is displayed as “No Caller ID” on smart phones. Concern about cybersecurity or data breaches, may impact on the ability to maintain accurate MTDM details