To serve patients by facilitating the creation of safe & effective advance care planning documents of all types (Living Will, DNR orders, POLST or MOLST) & to facilitate as well as enable the safe, timely & effective storage, retrieval & utilization of such documents with specified focus on patient safety.

Health Care Directives; When is it a Critical Illness vs. End of Life Care?

Real and Present Patient Safety Risk

Before we tell you what we do, we need to inform you of a Nationwide Patient Safety concern you may not be aware of.
The risk is real and represents a clear and present danger to you or your loved one!
The issue is often referred to as end of life (EOL) care and how you would want to be treated at end of life?  Now, advance directives, or advance care planning documents, most commonly living wills, do not resuscitate orders (DNR), and documents like POLST (physician orders for life-sustaining treatment) are tools utilized for advance care and EOL planning. Until recently they have not appeared to be a patient safety risk. These documents are well meaning and intended; however, they have in fact led to unintended consequences as reported in the New York Times on multiple occasions.

These documents are often created in legal jargon and then interpreted by health care professionals who have had no or very little training in what they are?

  • How they should be interpreted?
  • Who is allowed to interpret them?
  • More importantly, when they are to be followed?
  • Widely recommended & promoted.
  • May someday be a requirement at some stage in life.
Quite honestly, we at the Institute on HealthCare Directives fully support and promote their recommendation and utilization.  We however want to make them safer and better for you!

The Current State of Affairs

To bring us up to current speed, in a proposed regulation released July 8, 2015, CMS also known as Medicare, introduced two new billing codes for advance care planning provided to Medicare beneficiaries.  In January of 2016, with CMS now reimbursing medical professionals for EOL counseling, we can anticipate advance directives to be an increasingly critical part of medical decision-making.  Research, known as the TRIAD (The Realistic Interpretation of Advance Directives) series, indicates that practitioners often make assumptions about the content of such documents without actually reading them.  Interestingly, somehow, the medical profession has no requirements to assure competency and understanding of such documents.  Additionally, the term medical professional is getting diluted to professions other than the physician. Here is a very timely example from the Boston Herald of a man who died because of poor medical system processes and healthcare provider understanding.
More recently, the Joint Commission has publicly stated that “Patient safety and end-of-life care must not be, and are not, mutually exclusive. End-of-life issues are crucial for maintaining patient safety, which is a central aim of quality. “We now know that this area represents a nationwide patient safety issue”.   These same concerns were featured in a Wall Street Journal article by Laura Landro – How to Make Your Wishes for End of Life Care Clear.


Your voice as the patient “Should & Must” be heard. Too often though, health care providers, of all types, do not honor and respect a patient or health care agent’s wishes for aggressive treatment or more conservative treatment to allow a natural dying process.
The Institute on Healthcare Directives ensures that your voice will be heard & will do so by offering a customized video Resuscitation Safety Statement that is quickly and easily retrievable by medical personnel any time, day or night.
For those patients or families with more intensive needs or care concerns, we also offer a VIP Concierge Advocate service available 24/7/365. With this service you will always be protected with immediate & real time guidance to your concerns or questions by a physician who has been trained by the Institute on Health Care Directives.

Basic Package

  1. We will customize your video Resuscitation Safety Statement.
  2. Assist with recording the Safety Statement
  3. Proof the message/video for safety compliance checks.
  4. Assure the link with the QR Response Code.
    - Testing for speed of retrieval
    - Audio quality and closed captioning
  5. We will then review this with you and once we both approve, we will create your My Resusciatation Choices safety cards and provide you with 2 cards.

VIP Concierge Advocate

  1. Includes the Above Basic Package & Storage Fees
  2. Includes Medical Decision Support 24/7 365 days per year with a Board Certified Physician trained by the Institure on HealthCare Directives.
    - This service can be made to include support for our legally appointed HealthCare Agent or the Institute can be appointed to be your legally appointed HealthCare Agent.
    -This service will act on your behalf and will not be biased by institution practices or payer restrictions.
  3. For the following year, the service drops and remains that price unless a new message or video creation is required.
  4. Includes 2 copies of your My Resuscitation Choices safety card.

Our Brochure

Download our comprehensive brochure covering our services.

Dr. Ferdinando Mirarchi

Resources & Media

Time to Get it Right at the End-of-Life (MedPage Today)

Erie Doctor Opens Office to Help with End-of-Life Decisions (Erie Times News)

Doctors Are Confused by Living Wills, Study Finds (The Philadelphia Inquirer)

Video Messages Clarify Patients Wishes for Critical Versus End-of-Life Care (Wolters Kluwer)

Grieving Daughters Do Not Resuscitate Nightmare (Boston Herald)

DNR Confusion Poses a Public Safety Concern (Boston Herald)

Medical Due Diligence: A Living Will SHould Spell Out the Specifics (New York Times)

Putting Muscle Behind End-of-Life Wishes (New York Times)

How to Make Your Wishes for End-of-Life Care Clear (Wall Street Journal)

National Patient Safety Foundation

Educational Modules

Physicians Orders for Life Sustaining Treatment

How to Interpret a Living Will

What do DNR Orders Really Mean

Potential Pitfalls on POLST

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