MOLST Update

Katie Orem, MPH
MOLST & eMOLST Program Director

During the era of COVID-19 many health systems and the associations of hospitals and nursing homes have reached out to our team for help and assistance in managing best practices regarding end-of-life discussions and MOLST completion. We continue to recommend eMOLST implementation for all levels of care. Importantly, we will also be offering our current partner organizations additional benefits (particularly see #3 below) during this crisis to help them manage this population of their most seriously ill patients.

1. eMOLST at its core serves as a list of the very sickest patients who are most likely to suffer the worst outcomes if infected with COVID-19. Organizations can use these lists to help target their care management efforts and create care plans for those who wish to avoid hospitalization.
2. eMOLST houses data about specific critical medical orders such as CPR/DNR, respiratory support orders, and hospitalization orders that are accessible 24/7, including across care settings. Accessing the orders at the point of care ensures patients are receiving treatment in line with their preferences and avoiding unwanted interventions.
3. For the first time ever we are working to make the eMOLST parsed order sets available to partner health systems for their eMOLST patients en masse (vs. viewing every order individually). The eMOLST Administrator will be reaching out with these data based on patient volumes and location within New York State.
4. Skilled nursing facilities, primary care, specialty practices and hospices will all need to focus energy on additional care planning for their seriously ill patients and particularly for those who would like to avoid hospitalization. eMOLST will provide a consolidated list of those orders.
5. eMOLST offers a streamlined process for high-quality goals for care discussions and authorizing end-of-life medical orders, including ensuring ethical compliance which is essential during this crisis.
6. After thoughtful discussions, patients may want their resuscitation, respiratory support and/or hospitalization preferences updated in light of the COVID-19 crisis. Review and renew is easiest with the eMOLST system.

We recognize that many health systems and organizations are feeling an additional sense of urgency regarding offering appropriate end-of-life discussions to seriously ill patients who may want to avoid specific life-sustaining treatments. eMOLST provides a framework for these conversations and provides guard rails to ensure the process is offered to patients who are clinically appropriate and that the decisions are made in a patient-centered, ethical and legal way. We encourage all organizations to gain access to eMOLST to retrieve orders for the tens of thousands of patients with existing orders in the system and initiate eMOLST discussions with all clinically appropriate patients that they see in their care settings.