Using the Electronic Medical Record to Address Code Status Documentation: A Quality Improvement Project.

Area of Science:

• Medical Informatics
• Healthcare Quality Improvement
• Clinical Decision Support

Background:

• Code status (CS) documentation is frequently overlooked during hospital admissions, particularly for patients with end-stage conditions.
• Inadequate CS discussions can lead to care misalignments with patient wishes.

Purpose of the Study:

• To evaluate the effectiveness of an electronic medical record (EMR) pop-up alert combined with provider education in improving code status documentation.
• To assess the impact of interventions on addressing various aspects of patient code status.

Main Methods:

• A quality improvement project involving a baseline chart review of 1828 patients.
• Implementation of an EMR pop-up alert and physician education.
• A postintervention chart review of 1775 patients to assess changes in CS documentation.

Main Results:

• Significant improvements were observed in addressing code status, being full code, and documentation of cardiopulmonary resuscitation, intubation, vasopressor use, and cardioversion technique (p < .001).
• Postintervention, patients were twice as likely to have their code status addressed (OR = 2.04, p < .001), even after adjusting for multiple clinical factors.
• Documentation of do not resuscitate orders did not significantly change.

Conclusions:

• The combined intervention of EMR alerts and provider education effectively enhanced code status documentation in hospitalized patients.
• This quality improvement strategy demonstrates a successful method for improving critical care communication and alignment with patient preferences.