Assessing Goals-of-Care Documentation during the COVID-19 Patient Surge in an Academic Safety-Net Medical Center
Department of Family Medicine and Community Health; Department of Medicine, Division of Palliative Care
Health and Medical Administration | Health Services Administration | Infectious Disease | Palliative Care | Virus Diseases
Context/Objectives: It is paramount that clinicians assess and document patients' priorities to guide goal-concordant interventions, especially during a public health crisis.
Design: Retrospective chart review.
Setting: Academic safety-net medical center in central Massachusetts, United States.
Methods: We examined electronic medical records (EMRs) to discern goals-of-care (GOC) conversations with COVID-19 patients seen at some point by palliative care during their hospitalization, and all clinicians' use of a structured note template during the peak incidence of COVID-19 from March to May 2020. Patients were grouped based on comorbidities and preadmission living situation. GOC discussions were categorized into three types: code status decisions, other treatment decisions, and no treatment decisions.
Results: Nearly all (97%) patients had GOC documentation within 48 hours of admission. Forty-four percent of first GOC conversations incorporated the template. Patients with dementia living in nursing facilities had GOC documentation within hours of hospital admission, whereas healthier patients had their first GOC conversation at one week of hospitalization. Decisions about code status predominated in the first (83%) and second (49%) discussions, followed by a focus on other treatment decisions in subsequent discussions (44%-57%). Many did not require a treatment decision (19%-27%) but focused on quality-of-life definitions. Nearly all survivors were discharged to a facility and only four patients returned home. Many survivors died within three months (case fatality rate: 77%).
Conclusions: GOC documentation using a structured template combined with easy EMR retrievability and clinician training holds promise for aligning patients' values with real-time medical decisions, during and after the pandemic.
COVID-19, electronic medical record, goals-of-care documentation
DOI of Published Version
Reidy J, Savageau JA, Sullivan K, Nagpal V. Assessing Goals-of-Care Documentation during the COVID-19 Patient Surge in an Academic Safety-Net Medical Center. J Palliat Med. 2021 Aug 17. doi: 10.1089/jpm.2021.0172. Epub ahead of print. PMID: 34403601. Link to article on publisher's site
Journal of palliative medicine
Reidy J, Savageau JA, Sullivan K, Nagpal V. (2021). Assessing Goals-of-Care Documentation during the COVID-19 Patient Surge in an Academic Safety-Net Medical Center. COVID-19 Publications by UMass Chan Authors. https://doi.org/10.1089/jpm.2021.0172. Retrieved from https://escholarship.umassmed.edu/covid19/293