title: Emergency Physicians' Experience with Advance Care Planning Documentation in the Electronic Medical Record: Useful, Needed, and Elusive.
abstract: For patients' preferences to be honored, emergency department (ED) physicians must be able to find and use advance care planning (ACP) information in the electronic medical record (EMR). ED physicians' experiences with ACP EMR documentation and their documentation needs are unknown.
  
  
  
  We surveyed 70 ED physicians (81% response rate) from a tertiary and county ED. Our primary outcome was confidence finding and using ACP EMR documentation (percentage reporting very/extremely on a five-point Likert scale). Secondary outcomes included frequency of use and perceived usefulness of types of ACP documentation. Suggestions for improvement were analyzed using thematic content analysis.
  
  
  
  Participants' mean age was 36 years (± 9) and 54% were women. Thirty-one percent reported being very/extremely confident they could find ACP EMR documentation, and 55% felt very/extremely confident they could use it to care for patients. Yet 74% needed it ≥1 time/week and 43% ≥5 times/week. Participants reported code status orders (90%), Physician Orders for Life Sustaining Treatment (POLST) (86%), and durable power of attorney for health care (78%) as very/extremely useful, followed by values statements (31%), oral directives (34%), and living wills (37%). ED physicians wanted highly visible ACP information, "on the main screen."
  
  
  
  EMR systems are not optimized to provide critical ACP information to ED physicians who lack confidence finding or using ACP EMR documentation to care for patients. Dedicated ACP information on the EMR home screen and tailored training may be needed to help ED providers find, use, and discuss ACP documentation to provide care aligned with patients' goals.
authors.affiliation: 1 Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.|2 Center for Palliative Care , Harvard Medical School, Boston, Massachusetts.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Lakin
authors.affiliation: 3 Department of Emergency Medicine, University of California , San Francisco, California.
authors.forename: Eric
authors.initials: E
authors.lastname: Isaacs
authors.affiliation: 3 Department of Emergency Medicine, University of California , San Francisco, California.
authors.forename: Erin
authors.initials: E
authors.lastname: Sullivan
authors.affiliation: 4 Supportive and Palliative Care Service, Division of Hospital Medicine, San Francisco General Hospital , San Francisco, California.|5 Department of Medicine, University of California , San Francisco, California.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Harris
authors.affiliation: 6 Division of Geriatrics, University of California , San Francisco, California.|7 San Francisco VA Medical Center , San Francisco, California.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: McMahan
authors.affiliation: 6 Division of Geriatrics, University of California , San Francisco, California.|7 San Francisco VA Medical Center , San Francisco, California.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Sudore
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D004282:Documentation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D016224:Living Wills; D008297:Male; D010820:Physicians