Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study.
Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care.



We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR.



In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality. Patient-reported completion of ACP and availability of ACP documentation in the EHR were assessed.



Among study patients (n = 104), 59% reported completing some form of ACP: living will 52%, heathcare power of attorney 54%, do not resuscitate 38%, and medical orders for scope of treatment or physician orders for life-sustaining treatment 6%. Whites were more likely to report having some form of ACP than minorities (66% vs. 37%, p < 0.01), as were patients aged ≥80 years than those aged 65-79 (79% vs. 44%, p < 0.01). Only 13% of all patients had either a current code status or any other current ACP documentation in the EHR. Among patients whose primary care provider uses the same EHR system as the study ED, only 19% had a current code status or any other ACP documentation in the EHR.



In a sample of older ED patients likely to benefit from ACP, few patients had documented end-of-life care preferences in the EHR.
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.|2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.
Timothy F
TF
Platts-Mills
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.
Natalie L
NL
Richmond
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.
Eric M
EM
LeFebvre
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.
Sowmya A
SA
Mangipudi
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.
Allison G
AG
Hollowell
3 Department of Emergency Medicine and School of Nursing, University of North Carolina , Chapel Hill, North Carolina.
Debbie
D
Travers
1 Department of Emergency Medicine, University of North Carolina , Chapel Hill, North Carolina.|2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.
Kevin
K
Biese
2 Division of Geriatric Medicine, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.
Laura C
LC
Hanson
4 Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.
Angelo E
AE
Volandes
D032722:Advance Care Planning / Q000706:statistics & numerical data*; D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004282:Documentation / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015144:Southeastern United States