Errors in Electronic Health Record Advance Care Planning Documentation: It's a Patient Safety Issue

Centralized locations in the electronic health record (EHR) improve access to advance care planning (ACP) information; however, the prevalence of documentation errors in these locations is unknown.

In this cross-sectional study, we included primary care patients aged ≥65 years or ≥18 years with a serious illness. We verified errors using keyword queries and categorized them as "Patient Safety Errors" (e.g., ACP not in the centralized location) or "Noise Errors" (e.g., non-ACP in the centralized location). Associations between patient characteristics and errors versus no errors were evaluated using bivariate analysis.

Among 10,767 patients, 5374 (49.9%) had ACP in their EHR, and 495 (9.2%) of those had a verified error; 32.9% were Patient Safety Errors. Patients with errors were more likely to self-identify as from a minoritized population, be non-English speaking, and have a serious illness (p < 0.001).

Identifying documentation errors can help health systems create solutions for reliably scanning and storing patients' wishes and decreasing disparities.