Absence of Medical Record Documentation of Advance Care Planning Status in At-Risk Emergency Department Patients.

Authors

Jessica K. Eygnor DO, Lehigh Valley Health NetworkFollow
Jennifer Allen MD, Lehigh Valley Health NetworkFollow
William Carmichael, Lehigh Valley Health NetworkFollow
Katie Best RN, Lehigh Valley Health NetworkFollow
David B. Burmeister DO, FACEP, CPE, Lehigh Valley Health NetworkFollow
Katelyn McLain, Lehigh Valley Health NetworkFollow
Zhe Chen MD, Lehigh Valley Health NetworkFollow
Justin Stauffer PA-C, Lehigh Valley Health NetworkFollow
Courtney Moore MD, Lehigh Valley Health NetworkFollow
Anthony Schinelli, Lehigh Valley Health NetworkFollow
David M. Richardson MD, Lehigh Valley Health NetworkFollow
Matthew McCambridge MD, Lehigh Valley Health NetworkFollow
Marna R. Greenberg DO, MPH, FACEP, Lehigh Valley Health NetworkFollow
Timothy J. Friel MD, Lehigh Valley Health NetworkFollow

Publication/Presentation Date

8-1-2025

Abstract

Background The majority of those aged 65 and older will visit the emergency department (ED) in the last six months of life. Knowing a patient's goals of care is important, and existing medical records do not always represent them well. We set out to determine the baseline availability of advance directives and goals of treatment in those ED patients at increased risk for mortality. Methods This prospective cohort study included a sample of adult ED patients who had a mortality predictor by an End-of-Life (EOL) Deterioration Index-guided electronic best practice advisory (BPA) or admission to any of the network's intensive care units (ICU). Electronic medical record (EMR) abstraction was used to evaluate for documentation of healthcare proxy, healthcare power of attorney (POA), living will, advance care plans, or physician orders for life-sustaining treatment (POLST). Results A total of 9,321 patient encounters, representing 7,204 unique patients, were included in the analyzed sample. Most patients' charts lacked advance care planning documentation such as healthcare proxy (98.7%, N=9200), healthcare POA (93.0%, N=8665), living will (94.6%, N=8816), advance care planning status (66.8%, N=6226), and POLST (95.8%, N=8928). Overall, urban sites had a larger percentage of encounters in which a high-risk patient might benefit from advance care planning discussions than rural sites. Females had a higher percentage of documentation across all variables of goals of care, with significant differences in healthcare POA (p < 0.001), advance directives (p < 0.001), and POLST (p = 0.008). Conclusions The majority of patients with a higher risk for mortality, as indicated by an EOL Deterioration Index-guided BPA or hospital ICU admission, do not have documentation in the EMR across all variables of goals of care.

Volume

17

Issue

8

First Page

89248

Last Page

89248

ISSN

2168-8184

Published In/Presented At

Eygnor, J. K., Allen, J. E., Carmichael, W. G., Best, K. M., Burmeister, D. B., McLain, K. L., Chen, Z., Stauffer, J. M., Moore, C. M., Schinelli, A., Richardson, D. M., McCambridge, M. M., Greenberg, M. R., & Friel, T. J. (2025). Absence of Medical Record Documentation of Advance Care Planning Status in At-Risk Emergency Department Patients. Cureus, 17(8), e89248. https://doi.org/10.7759/cureus.89248

Disciplines

Medicine and Health Sciences

PubMedID

40901230

Department(s)

Department of Emergency Medicine, Department of Medicine, Section of Palliative Medicine and Hospice, Patient Care Services / Nursing, USF-LVHN SELECT Program, USF-LVHN SELECT Program Faculty, USF-LVHN SELECT Program Students, Administration and Leadership

Document Type

Article