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Cited by 61Palliative Care and End-of-Life IssuesElectronic Health Records SystemsNursing Diagnosis and Documentation

An Electronic Medical Record Intervention Increased Nursing Home Advance Directive Orders and Documentation

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Lindner, Serge A., Ben Davoren, J., Vollmer, Andrew, Williams, Brie, Seth Landefeld, C.·2007·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2007.01214.x
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Abstract

OBJECTIVES: To develop an electronic medical record intervention to improve documentation of patient preferences about life‐sustaining care, detail of resuscitation and treatment‐limiting orders, and concordance between these orders and patient preferences. DESIGN: Prospective before–after intervention trial. SETTING: Veterans Affairs nursing home with an electronic medical record for all clinical information, including clinician orders. PARTICIPANTS: All 224 nursing home admissions from May 1 to October 31, 2004. MEASUREMENTS: Completion of an advance directive discussion note by the primary clinician, clinician orders about resuscitation and other life‐sustaining treatments, and concordance between these orders and documented patient preferences. INTERVENTION: The electronic medical record was modified so that an admission order would specify resuscitation status. Additionally, the intervention alerted the primary clinician to complete a templated advance directive discussion note for documentation of life‐sustaining treatment preferences. RESULTS: Primary clinicians completed an advance directive discussion note for five of 117 (4%) admissions pre‐intervention and 67 of 107 (63%) admissions post‐intervention ( P <.001). In multivariate analysis, the intervention was independently associated with advance directive discussion note completion (odds ratio=42, 95% confidence interval=15–120). Of patients who preferred do‐not‐resuscitate (DNR) status, a DNR order was written for 86% pre‐intervention versus 98% post‐intervention ( P =.07); orders to limit other life‐sustaining treatments were written for 16% and 40%, respectively ( P =.01). CONCLUSIONS: A targeted electronic medical record intervention increased completion of advance directive discussion notes in seriously ill patients. For patients who preferred DNR status, the intervention also increased the frequency of DNR orders and of orders to limit other life‐sustaining treatments.

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  • Even in the ED's aggressive care setting, routine code status conversations can make patients' status clearer before inpatient admission.

    “Regular code status discussions, despite the ED's aggressive care nature, can enhance clarity on patients' code status prior to inpatient care.17,18”

    From In-Hospital Code Status Updates: Trends Over Time and the Impact of COVID-19 (2024) · cites this paper as [18]

    The Discussion (page unavailable) reports improved documentation of advance-directive discussions and greater concordance between resuscitation orders and patient preferences, supporting the general point about clearer code status. But the study concerns nursing-home admissions, not discussions in an emergency department before inpatient admission. The Intervention section also says the intervention did not actively target patient–clinician discussions. (LLM, conf=0.86)

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Research works printed but not linked: 3

  1. [22]22. Cantor MD. Improving advance care planning: Lessons from POLST. Physi- cian Orders for Life-Sustaining Treatment. J Am Geriatr Soc 2000;48:1343- 1344.
  2. [25]25. Batalden PB, Stoltz PK. A framework for the continual improvement of health care: Building and applying professional and improvement knowledge to test changes in daily work. Jt Comm J Qual Improv 1993;19:424-447; discussion 448-452.
  3. [34]34. Batalden PB, Nelson EC, Roberts JS. Linking outcomes measurement to con- tinual improvement: The serial ''V'' way of thinking about improving clinical care. Jt Comm J Qual Improv 1994;20:167-180.

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Authors
Lindner, S. A., Ben Davoren, J., Vollmer, A., Williams, B., & Seth Landefeld, C.
Affiliations
San Francisco VA Medical Center (US)
Corresponding author
Lindner, Serge A.
ORCID
Williams, Brie
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2007-06-18
Volume
55
Issue
7
Pages
1001-1006
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2007.01214.x
OpenAlex
W1529040447
Cited by
61
References
35
Citations by year
2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 6 · 2016: 1 · 2015: 3 · 2014: 7 · 2013: 4 · 2012: 9
FWCI
1.72
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Hartford Foundation for Public Giving
  • Health Services Research and Development
  • University of California, San Francisco
  • National Institute on Aging (AG000212, AG000912)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
Keywords
electronic health records, advance directives, nursing homes, do-not-resuscitate orders, life-sustaining treatment preferences, clinician documentation, veterans, serious illness
MeSH terms
Aged, Documentation, Female, Humans, Male, Nursing Homes, Patient Admission, Prospective Studies, Quality Assurance, Health Care, Multivariate Analysis, Odds Ratio, Advance Directives, Medical Records Systems, Computerized, Resuscitation Orders

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