Advanced directives and code status documentation in an academic practice

Although advance directives (AD) allow patients a voice during their end-of-life care, less than 20% of US individuals have one. We investigated how physicians, both attendings and residents, of the Sioux Falls Family Medicine Residency Program (SFFMRP) were addressing AD and code status with our geriatric population, which has an increased need for advance directive implementation secondary to declining health.

We used a retrospective design, in which a random sampling of charts was performed. The setting was the SFFMRP and associated facilities Participants included a chart review of 121 patients over age 65 seen by a SFFMRP physician within the past year. Percentages were calculated looking at overall outcomes, living situation, age, and resident versus attending involvement. Statistical significance was evaluated using Chi square analysis.

Overall, 44% of all individuals examined had an advanced directive (80.6% of nursing home (NH) patients, 76% of assisted living (AL) patients, and 21% of independent living patients). Evaluating code status, 55% of all individuals had a known code status (100% of NH patients, 92% of AL patients, and 25% of independent living patients). No significant difference was found when comparing attending versus resident physicians' patient groups.

SFFMRP geriatric patients are more likely than the national population to have an AD, but more than half of patients still have no known documentation in place. The living situation of a patient significantly affects whether an AD or known code status is present, indicating that focus should be placed on independent living patients completing these documents.