A Medical Treatment Decision Maker (MTDM), also referred to as surrogate decision maker, by law, is to be appointed to make medical treatment decisions on behalf of a person who cannot make such decisions for themselves. In the Emergency Department (ED) and acute healthcare services, the clinicians’ (nurses and doctors) ability to contact MTDMs is essential for patient care, particularly in time-critical situations. Our primary objective was to review the verification process and assess the accuracy of MTDM contact numbers in the Health Information System (HIS) to assess compliance with legislation. We used a quantitative method with retrospective observational study design and follow-up phone interview transcript. One hundred and fifty-nine participants were randomly selected of whom 76 % had MTDM. 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).

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

Background: Emergency department staff awareness, access and implementation of advance care directives and goals of care documents and the related patient consent processes are important but not well un-derstood.Methods: A cross-sectional survey using purposive sampling was undertaken at a tertiary hospital's Emergency Department from 15th March to 26th April 2021. Participants were recruited through online platforms. Pre-validated questionnaires were distributed by email or as QR codes on bulletin boards. Data collected included staff: demographics, knowledge, access and implementation of advance care directives and goals of care documentation.Results: One hundred thirty-four (28%) of 476 targeted participants responded with nursing forming largest group. Results showed that previous attendance of advance care planning education was low at 20%. Familiarity with advance care directive documentations was only 19% while with goals of care document was average. 61 (48%) respondents reported ease of accessing electronic documents and 21 (19%) reported feeling very comfortable discussing and setting goals of care with patients (p = < 0.01). Conclusions: Staff awareness of advance care directive was poor, while awareness of goals of care was average. There was no association between advance care directives awareness and staff age group, gender, length of: -professional practice, practice at the study site.Crown Copyright (c) 2021 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. All rights reserved.