Code status and resuscitation options in the electronic health record

Area of Science:

• Medical Informatics
• Health Services Research
• Patient Care

Background:

• Advance discussion and documentation of code-status are crucial for preventing undesired cardiopulmonary resuscitation and end-of-life interventions.
• Current paper-based code-status documentation is infrequent and limits its clinical usefulness.
• Electronic health record (EHR) integration offers a potential solution for accessible code-status documentation.

Purpose of the Study:

• To evaluate the implementation of a tool for documenting code-status within EHRs at a large teaching hospital.
• To analyze the data associated with code-status documentation in adult and pediatric patient populations.
• To identify factors influencing code-status documentation rates.

Main Methods:

• Retrospective analysis of 12 months of encounter data (April 2012-March 2013) from a large teaching hospital.
• Tracking of code-status attribute for individual adult and pediatric patients.
• Analysis included 131,399 encounters for 83,248 adults and 80,778 encounters for 55,656 pediatric patients.

Main Results:

• Code-status was documented for 71% of adult patients and 30% of pediatric patients.
• Patient age and severity of illness were significant factors influencing code-status documentation.
• Demographic factors including gender, race, ethnicity, and geographic proximity were also associated with documentation rates.

Conclusions:

• The absence of documented code-status can lead to unnecessary medical interventions.
• Electronic documentation of code-status provides readily accessible information for care providers, especially during emergencies.
• Integrating code-status documentation into EHRs enhances care provider access and supports patient end-of-life preferences.