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An Electronic Health Record-Assisted Patient Safety Intervention to Identify Missing Code Status Orders in Patients
Emily Jacobson1,2, Alex Harris1, Shuo Tian1
1Department of Internal Medicine, University of Michigan Health, Ann Arbor, Michigan, USA.
Journal of Palliative Medicine
|June 24, 2026
Summary
An electronic health record alert improved documentation of do-not-attempt-resuscitation (DNAR) orders for hospitalized patients. This intervention enhanced patient safety by ensuring code status discussions and reducing the risk of unwanted interventions.
Area of Science:
- Medical Informatics
- Patient Safety
- Clinical Decision Support
Background:
- Serious illnesses in hospitalized patients often lack documented code status, risking goal-discordant care.
- Patients with prior do-not-attempt-resuscitation (DNAR) preferences may lack orders, posing a risk of undesired resuscitation.
Purpose of the Study:
- To evaluate an electronic health record (EHR) alert designed to prompt code status discussions.
- To assess the impact of the EHR alert on code status order documentation for hospitalized patients with prior DNAR or partial code status.
Main Methods:
- Implemented an EHR alert system in May 2025 for hospitalized medicine patients with prior DNAR or partial code status.
- Compared the proportion of patients with active code status orders and the timing of these orders before and after the alert implementation.
Main Results:
- The percentage of patients with an active code status order significantly increased post-implementation (96.4% vs. 89.6%, p < 0.001).
- A small proportion (6.1%) of code status orders were placed within five minutes of the EHR alert.
- The median time from admission to the first code status order increased post-intervention (8 vs. 7 hours, p = 0.03).
Conclusions:
- An EHR alert effectively increased code status order documentation for patients with prior DNAR or partial code status.
- Further research is recommended to extend these alerts to other hospital services and evaluate their impact on goal-concordant care.
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