Impact of electronic medical records and COVID-19 on adult Goals-of-Care document completion and revision in hospitalised general medicine patients.

作者：Curtis, Claire A; Nguyen, Maria U; Rathnasekara, Greasha K; Manderson, Rachel J; Chong, Mae Y; Malawaraarachchi, Janith K; Song, Zheng; Kanumuri, Priyanka; Potenzi, Bradley J; Lim, Andy K H

来源：Internal Medicine Journal, 2021.

DOI：10.1111/imj.15543

• Patient care planning
• COVID-19
• Goals-Of-Care
• electronic health records
• hospital medicine
• internal medicine
• resuscitation

BACKGROUND: Conversion from paper-based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals-Of-Care (GOC) documents during hospital admissions, and the COVID-19 pandemic may have further impacted this. AIMS: Determine the impact of EMR and COVID-19 on the proper completion of GOC forms, and the factors associated with inpatient changes in GOC. METHODS: We conducted a cross-sectional study of adult general medicine admissions (Aug 2018-Sep 2020) at Dandenong Hospital (Victoria, Australia). We used interrupted time series to model the changes in the rates of proper GOC completion (adequate documented discussion, completed ≤2 days) after the introduction of EMR and arrival of COVID-19. RESULTS: We included a total of 5147 patients. The pre-EMR GOC proper completion rate was 27.7% (overall completion, 86.5%). There was a decrease in the proper completion rate by 2.21% per month (95% CI: -2.83%, -1.58%) after EMR implementation despite an increase in overall completion rates (91.2%). The main reason for the negative trend was a decline in adequate documentation despite improvements in timeliness. COVID-19 arrival saw a reversal of this negative trend, with proper completion rates increasing by 2.25% per month (95% CI: 1.35%, 3.15%) compared to the EMR period, but also resulted in a higher proportion GOC changes within 2 days of admission. CONCLUSION: EMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID-19 reversed the negative trend in proper GOC completion but increased the number of early revisions.