Code Status Documentation Availability and Accuracy Among Emergency Patients with End-stage Disease.

Area of Science:

• Emergency Medicine
• Health Informatics
• Palliative Care

Background:

• Patients with end-stage disease may receive unwanted aggressive resuscitation if unable to communicate during emergencies.
• Accessible resuscitation wishes (code status) are crucial for emergency care and should be an electronic health record (EHR) metric.
• This study addresses the availability and retrieval speed of code status documents for end-stage disease patients in the emergency department (ED).

Purpose of the Study:

• To determine the percentage of end-stage disease patients with accessible code status documents in the ED.
• To assess the retrieval time for available code status documentation.
• To compare documented code status with patients' current resuscitation wishes.

Main Methods:

• Cross-sectional study of ED patients with end-stage disease.
• Standardized, timed review of health records and transfer documents.
• Interviews with patients and substitute decision-makers to verify code status.

Main Results:

• Code status documentation was unavailable within 15 minutes for 63% of patients.
• When available, retrieval was under five minutes, especially if "one click deep" in the EHR.
• 63% of interviewed patients wished "do not resuscitate," with 10 having no documentation; documented status was more likely for those in assisted-living or long-term care facilities.

Conclusions:

• Most end-stage disease patients lack readily available code status documents in the ED, risking unwanted resuscitation.
• Community-dwelling patients with advanced disease are at higher risk for unwanted interventions.
• Accessible EHR documentation is promising but requires validation for accuracy and validity.