• Olivia Pyles, Christopher M Hritz, Peg Gulker, Jansi D Straveler, Corita R Grudzen, Cole Briggs, and Lauren T Southerland.
• The Ohio State University College of Medicine (O.P.), Columbus, Ohio, USA; Division of Palliative Medicine, Department of Internal Medicine (C.M.H.), The Ohio State University, Columbus, Ohio, USA; Department of Emergency Medicine (P.G., L.T.S.), The Ohio State University, Columbus, Ohio USA; Clinical Analytics (J.D.S.), The Ohio State University Wexner Medical Center, Columbus, Ohio USA; Ronald O. Perelman Department of Emergency Medicine (C.R.G.), New York University School of Medicine, Department of Population Health, New York, New York, USA.
• J Pain Symptom Manage. 2022 May 1; 63 (5): e489e494e489-e494.

ContextEmergency Departments (EDs) care for people at critical junctures in their illness trajectories, but Advanced Care Planning (ACP) seldom happens during ED visits. One barrier to incorporating patient goals into ED care may be locating ACP documents in the electronic health record (EHR).ObjectivesTo determine the ease and accuracy of locating ACP documentation in the EHR during an ED visit.MethodsAcademic ED with 82,000 visits per year. The EHR system includes a Storyboard with the patient's code status and a link to ACP documents. A real-time chart audit study was performed of ED patients who were either ≥65 years old or had a cancer diagnosis. Data elements included age, Emergency Severity Index, ACP document location(s) in the EHR, Storyboard accuracy, ED code status orders, and discussions of ACP or code status.ResultsOf the 160 audited charts, 51 (32%) were for adults <65 years old with a cancer diagnosis. Code status was discussed and updated during the ED visit in 68% (n=108). ACP documents were found in 3 different EHR places. Only 30% (n=48) had ACP documents in the EHR, and of these (22%, n=13) were found in only one of the three EHR locations. The Storyboard was inaccurate for 5% (n=8). ED case managers frequently discussed APC documentation (78%, 43/55 charts).ConclusionsEven under optimal conditions with social work availability, ACP documents are lacking for ED patients. Multiple potential locations of ACP documents and inaccurate linkage to the Storyboard are potentially addressable barriers to ACP conversations.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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