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16 PATIENT EXPERIENCE Unconscious Patient's 'Do Not Resuscitate' Tattoo Creates Ethical Dilemma for ER Staff By Megan Knowles E mergency room staff at a Florida hospital found an unconscious patient with "do not resuscitate" tattooed on his chest, prompting confusion and ethical concern, according to a case report in e New England Journal of Medicine. Paramedics brought the unconscious 70-year-old man to the ER, where he was found to have an elevated blood alcohol level. e man had a history of chronic obstructive pulmonary disease, diabetes and an irregular heart rate. The "do not resuscitate" tattoo on his chest underlined "not," and included what staff presumed to be his signature. The man arrived at the ER with no identifica- tion or family present, which prompted the social work department to assist in contacting his next of kin. ER staff failed to help the patient regain a level of consciousness where he could adequately discuss his goals for care. The staff initially decided not to honor the patient's tattoo. They reasoned they should not make an irreversible choice due to the situation's uncertainty. However, this deci- sion left staff conflicted and they requested an ethics consultation. e ethics consultants advised staff to honor the patient's DNR tattoo. ey reasoned staff could infer the tattoo expressed the patient's authentic preference and added that laws are not always flexible enough to respect a patient's best interest. A DNR order was written and the social work department obtained a copy of the patient's Florida Department of Health "out-of-hospital" DNR order, which was con- sistent with his tattoo. e patient died aer his health continued to deteriorate through- out the night, without receiving CPR. "is patient's tattooed DNR request pro- duced more confusion than clarity, given concerns about its legality and likely un- founded beliefs that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated," the authors wrote. "We were relieved to find his written DNR request, especially because a re- view of the literature identified a case report of a person whose DNR tattoo did not reflect his current wishes." e case report authors noted this incident does not support or oppose the use of tattoos to express end-of-life wishes for patients who are incapacitated. n Study: One-Day Physician Communication Training Linked to Improved Patient Experience By Megan Knowles H ospitals that conduct one-day physician communication skills workshops may record improved patient experience and physician engagement up to six weeks later, according to a study in PXJ. The study examined a 7.5-hour, hospital wide physician communica- tion skills workshop in a large academic hospital system and its effects on attitudes and behaviors related to patient communication. The workshop covered areas such as empathy, eliciting concerns, agenda setting and shared decision-making. It included 490 participants from 21 medical and surgical specialties, which primarily consisted of attending level physicians. Data was collected through a web-based questionnaire, which par- ticipants received six weeks post-workshop. "A significant change in self-efficacy, attitudes, and behaviors related to communicating with patients occurred in nine out of 10 questions on the retrospective pre- post survey," the authors wrote. Additionally, providers who spent less time in patient care felt they elicited patient concerns more effectively and providers who had previ- ously participated in training were more likely to feel satisfied with how they conducted patient visits than prior to the workshop. n Geisinger Honors More Than 130 Providers for Excellent Patient Experiences By Megan Knowles D anville, Pa.-based Geisinger Health Sys- tem honored more than 130 caregivers recognized as "the best" by their pa- tients at the health system's annual Top Patient Experience Clinicians Awards Dinner. Geisinger applauded the providers Nov. 17, including physicians, physician assistants and certified registered nurse practitioners, for ranking among the top 10 percent in patient experience nationally among more than 80,000 providers who participate in Press Ganey pa- tient experience surveys. "The providers we honored are those who come to work every day and deliver the highest quality, the most compassionate, the most cul- turally sensitive care," said Geisinger president and CEO David Feinberg, MD. "Their focus, their true north, is on our patients." n