ArticleCureus2025
Absence of Medical Record Documentation of Advance Care Planning Status in At-Risk Emergency Department Patients.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
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.
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