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Cited by 10Electronic Health Records SystemsPalliative Care and End-of-Life IssuesMedical Coding and Health Information

The DOI matches its Crossref record; 15 of the 15 references it cites were found in a registry or an index.

Code Status Reconciliation to Improve Identification and Documentation of Code Status in Electronic Health Records

Open access
Jain, Viral G, Greco, Peter J, Kaelber, David C·2017·Applied Clinical Informatics
DOI 10.4338/aci-2016-08-ra-0133PMC PMC5373766
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Abstract

Summary: Background: Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues. Objective: To study the tools, workflow, and impact of clinical decision support (CDS) for CSR. Methods: We established rules for CS implementation in our EHR. At admission, a CS is required as part of a patient’s admission order set. Using standard CDS tools in our EHR, we built an interruptive alert for CSR at discharge if a patient did not have the same inpatient (current) CS at discharge as that prior to admission CS. Results: Of 80,587 admissions over a four year period (2 years prior to and post CSR implementation), CS discordance was seen in 3.5% of encounters which had full code status prior to admission, but Do Not Resuscitate (DNR) CS at discharge. In addition, 1.4% of the encounters had a different variant of the DNR CS at discharge when compared with CS prior to admission. On pre-post CSR implementation analysis, DNR CS per 1000 admissions per month increased significantly among patients discharged and in patients being admitted (mean ± SD: 85.36 ± 13.69 to 399.85 ± 182.86, p<0.001; and 1.99 ± 1.37 vs 16.70 ± 4.51, p<0.001, respectively). Conclusion: EHR enabled CSR is effective and represents a significant informatics opportunity to help honor patients’ end-of-life wishes. CSR represents one example of non-medication reconciliation at transitions of care that should be considered in all EHRs to improve care quality and patient safety.

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Metadata

Authors
Jain, V. G., Greco, P. J., & Kaelber, D. C.
Affiliations
  • Cincinnati Children's Hospital Medical Center (US)
  • MetroHealth (US)
Corresponding author
Kaelber, David C
ORCID
Venue
Applied Clinical Informatics
Publisher
Georg Thieme Verlag KG
Published
2017
Volume
26
Issue
01
Pages
226-234
ISSN
1869-0327 (ISSN-L)
DOI
10.4338/aci-2016-08-ra-0133
PMC
PMC5373766
OpenAlex
W2592613312
Cited by
10
References
15
Citations by year
2026: 1 · 2025: 2 · 2023: 3 · 2022: 2 · 2021: 1 · 2019: 1
FWCI
0.38
Type
journal article
Language
en
Open access
Locations
  • Applied Clinical Informatics (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Keywords
electronic health records, clinical decision support, do-not-resuscitate orders, end-of-life care, care transitions, medication reconciliation, interruptive alerts, patient safety, clinical workflow
MeSH terms
Documentation, Hospitalization, Humans, Terminal Care, Resuscitation Orders, Decision Support Systems, Clinical, Electronic Health Records

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