title: Code status and resuscitation options in the electronic health record.
abstract: OBJECTIVE
  The advance discussion and documentation of code-status is important in preventing undesired cardiopulmonary resuscitation and related end of life interventions. Code-status documentation remains infrequent and paper-based, which limits its usefulness. This study evaluates a tool to document code-status in the electronic health records at a large teaching hospital, and analyzes the corresponding data.
  
  
  METHODS
  Encounter data for patients admitted to the Medical Center were collected over a period of 12 months (01-APR-2012-31-MAR-2013) and the code-status attribute was tracked for individual patients. The code-status data were analyzed separately for adult and pediatric patient populations. We considered 131,399 encounters for 83,248 adult patients and 80,778 encounters for 55,656 pediatric patients in this study.
  
  
  RESULTS
  71% of the adult patients and 30% of the pediatric patients studied had a documented code-status. Age and severity of illness influenced the decision to document code-status. Demographics such as gender, race, ethnicity, and proximity of primary residence were also associated with the documentation of code-status.
  
  
  CONCLUSIONS
  Absence of a recorded code-status may result in unnecessary interventions. Code-status in paper charts may be difficult to access in cardiopulmonary arrest situations and may result in unnecessary and unwanted interventions and procedures. Documentation of code-status in electronic records creates a readily available reference for care providers.
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States. Electronic address: haresh.bhatia@vanderbilt.edu.
authors.forename: Haresh L
authors.initials: HL
authors.lastname: Bhatia
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Patel
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States.
authors.forename: Neesha N
authors.initials: NN
authors.lastname: Choma
authors.affiliation: Informatics Center, Vanderbilt University School of Medicine, Nashville, TN, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grande
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States; Informatics Center, Vanderbilt University School of Medicine, Nashville, TN, United States.
authors.forename: Dario A
authors.initials: DA
authors.lastname: Giuse
authors.affiliation: Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D024362:Advance Directive Adherence / Q000592:standards / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation; D002648:Child; D039702:Current Procedural Terminology; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010358:Patient Participation; D016414:Resuscitation Orders; D013727:Terminal Care / Q000191:economics / Q000379:methods; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data
keywords: Advance directives; Code status; Electronic health record; End of life care; Provider communication