Psychiatric Advance Directives: An Analysis of Current Usage at a Large County Hospital

Background/Purpose: Approximately one third of adults in the United States complete a Medical Advance Directive in their lifetime. However, few complete a Psychiatric Advance Directive (PAD), despite the high prevalence of psychiatric illness. PADs help those with mental illness specify their care preferences during periods of acute psychiatric illness. Given the minimal research regarding PAD usage, the use of PADs in clinical practice remains poorly understood. This study aims to use electronic health record (EHR) data to investigate and describe PAD usage in a large, county health system. Methods: EHR data for all patients 18 years and older with a 2022 inpatient or observation discharge were retrieved. A sample of these patients who had scanned Advance Directive documents were reviewed to assess for the presence of a PAD. Results: A total of 41,421 patients were included in this EHR analysis. No PAD documents were found in this population. Conclusion: Although the PAD template was published on the hospital website, we found no evidence of completed PADs at our facility. Further work is needed to educate providers on the importance of PADs and promote appropriate and inclusive PAD usage at the health system level. Relevance to Clinical Practice: This research identifies a significant gap in PAD utilization and emphasizes the potential for increased PAD use in clinical care. It highlights current obstacles to PAD implementation while offering actionable next steps for how PADs can fit into the larger flow of patient care.