POLST / Portable Medical Orders
POLST = Physician Orders for Life-Sustaining Treatment. It's a medical order, not an advance directive.
A POLST Is a Medical Order
A POLST (Physician Orders for Life-Sustaining Treatment) is a signed medical order — not a legal document, not an advance directive, and not a code status checkbox in the chart. It travels with the patient across care settings and is immediately actionable by EMS, hospital staff, and nursing facility personnel.
The name varies by state: POST, MOLST, MOST, POLST — same concept, different acronym. Know what your state uses.
POLST vs Advance Directive vs HCPOA
An advance directive documents future preferences — it requires interpretation. A POLST is already interpreted: it is the order that results from a goals-of-care conversation.
A healthcare power of attorney designates a decision-maker. A POLST documents the decisions. These are complementary, not interchangeable.
Who Should Have One
POLST is appropriate for patients with serious illness, advanced frailty, or a prognosis of approximately one year or less — not for healthy adults with no serious illness.
The form is the output. The goals-of-care conversation is the clinical work. A POLST completed without a real conversation about prognosis and values is a missed opportunity.
Review It at Transitions
A POLST should be reviewed — and updated if needed — at every significant transition: hospitalization, discharge, change in prognosis, or expressed change in patient preferences.
An outdated POLST can be as harmful as no POLST. A patient who previously wanted full resuscitation may have different goals after a major clinical event.
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