Related Experiment Video
Updated: Apr 19, 2026
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Effect of Emergency Department-Initiated Video-Enhanced Advance Care Planning on Documentation and Goal-Concordant
Angelo E Volandes1,2,3,4,5, Hacho Bohossian6, Yuchiao Chang7
1Department of Medicine, Dartmouth Health, Lebanon, NH, USA. angelo.e.volandes@hitchcock.org.
Background:
Advance care planning (ACP) is widely promoted; however, it remains unclear if documentation translates to goal-concordant care aligned with patient values.
Objective:
To determine whether emergency department-initiated video-enhanced ACP increases documentation and improves goal-concordant care among decedents.
Design:
Multicenter, parallel-group randomized trial (2022-2024, follow-up to 2025). Outcome assessors were blinded to assignment.
Setting:
Three emergency departments.
Participants:
Adults aged ≥ 65 or 50-64 with serious illness.
Interventions:
Intervention group (a) viewed an ACP video, (b) had an ACP conversation, and (c) triggered electronic health record provider notification. Controls received usual care.
Main Measures:
Primary outcome was ACP documentation within 3 months. Secondary outcomes included goals-of-care preferences, ACP knowledge (1-5), engagement (1-4), and documentation at 6 months. Goal concordance used a 10-point scale (10 = perfect concordance).
Key Results:
598 patients (298 intervention, 300 control; mean age 73.5 ± 8.1 years; 53.7% women) were randomized. At 3 months, ACP documentation was significantly higher in the intervention group (45.6% [136/298] vs. 31.3% [94/300]; rate difference [RD] = 14.3%, 95% CI 6.6%-22.0%; P < .001), persisting at 6 months (52.3% vs. 39.3%; RD = 13.0%, 95% CI 5.1%-20.9%; P = .002). ACP knowledge (4.1 vs. 3.1; mean difference [MD] = 1.0, 95% CI 0.9-1.2; P < .001) and engagement (4.1 vs. 3.9; MD = 0.2, 95% CI 0.1-0.3; P = .004) were greater in the intervention group compared to the control. There were no differences in goals-of-care preferences between the two study arms. Among 94 decedents (53 intervention, 41 control), intervention recipients had substantially higher goal-concordance scores (median 10 [IQR 8-10] vs. 7 [IQR 3-10]; P < .001).
Conclusions:
Video-enhanced ACP increased documentation rates. Among decedents, goal-concordance was higher in the intervention group, suggesting ED-initiated ACP may help align care with patient preferences.
Trial Registration:
Clinicaltrials.gov identifier: NCT04931797 (posted June 1, 2021).
More Related Videos
Related Concept Videos
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:26Methods of Documentation IV: Focus Charting
It typically involves three columns for recording information:
01:08Role of Communication in the Nursing Process III: Evaluation and Documentation
01:23Methods of Documentation V: CBE
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...
01:26Guidelines for Nursing Documentation II
Timely documentation is crucial to ensure continuity of care for patients. Any delays in recording or reporting medical information can result in medical errors and even adverse patient outcomes. From medication administration to diagnostic test results, every detail must be accurately and promptly documented to provide the best possible care for patients.