A Mixed Methods Analysis of Standardized Documentation of Serious Illness Conversations Within an Electronic Health Record Module During Hospitalization.
Myrna Katalina Serna, Catherine Yoon, Julie Fiskio and 3 others
PMID 38334010WHAT IT FOUND
First standardized documentation of a serious-illness conversation was recorded for 59 hospitalized patients with mean age 82; 49 listed other physical suffering as a worry, 36 listed pain, 52 hoped for comfort, 27 for home, and 18 died within 6 months.
Key findings
0159 of 5,142 patients had first standardized documentation of a serious-illness conversation during general medicine hospitalization; their mean age was 82 years.
0245 (76%) had a palliative care consultation, 35 (59.3%) were discharged DNR/DNI, and 18 (30.5%) died within 6 months.
03The most common documented hopes were comfort (52, 88%) and home (27, 46%), and the most common worries were other physical suffering (49, 83%) and pain (36, 61%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one hospital. Only 59 of 5,142 patients had first standardized documentation, so the sample may be biased toward patients whose teams used the module. Conversations recorded elsewhere in the electronic health record were not captured. The notes are a clinician's interpretation of the conversation, not the conversation itself. The radio-button choices may have influenced what was selected and documented.
The easy way to misread this
Do not conclude that standardized serious-illness documentation improves outcomes. The study only describes records from 59 patients who had documentation, not patients without it, and the notes are a clinician's interpretation rather than the conversation itself.