Advanced Trainee in General Medicine and Physicians Education Fellow at Monash Health
Impact Of Electronic Health Records And COVID-19 On Adult Goals Of Care Completion And Revision In Hospitalised General Medical Patient
Aims: The primary aim of this study is to compare the rates of proper completion of goals of care (GoC) in the pre-electronic medical record (EMR), post-EMR and COVID-19 periods, to determine how these events have affected the timeliness and adequacy of discussion and documentation of GoC. The secondary aim of this study is to determine the factors which affect categorial GoC changes during a general medicine admission across the three periods.
Methods: This is a single centre, cross sectional study conducted at Dandenong Hospital. We used the hospital database to identify all adult patients admitted under general medicine from August 2018 – September 2020. We then selected a random sample of 200 patients for each calendar month. For each of these patients we calculated their Charlson Comorbidity Index and recorded any neuromuscular disease, chronic pain and obesity. We then looked at each patient’s Goals of Care form. We defined timely as occurring within two calendar days of admission date, and adequate discussion was having the 'reason for' and 'discussed with' sections being filled out. If 'previously discussed' was chosen, these sections needed to be filled out on the previous form. Proper completion required both the timely and adequate discussion criteria. The secondary outcome was to determine the timing of changes, reason and person/team implementing the change.
(Preliminary) Results: 10% of patients did not have a completed goals of care form. 81% were unchanged throughout the admission, 1% were changed more than once. Most forms were changed within the first 24hrs of a patient’s admission, 80% were changed by the treating team. Only 7% of initial forms were discussed with a consultant, as opposed to 84% upon changing the form. Only 27% of initial forms had adequate documentation. Interestingly we found that in changing to the electronic medical record; the number of missing goals of care forms went down significantly but the number of improperly completed goals of care forms went up.
Conclusions and/or Clinical Practice Point: We conclude that the introduction of an electronic medical record increases partial completion of GoC form, however the targets for proper completion were less likely to be reached. Further research into why this occurs is required. We also conclude that if a GoC form was changed it was usually within the first 24hrs of admission in conversation with the treating team consultant. References: Potenzi B, Lim AKH. Patient factors affecting the proper completion of a Goals of Care form in a general medicine hospital admission. Intern Med J. 2019; doi:10.1111/imj.14703