Background: Assessing severity of illness using available electronic medical record (EMR) data on admission and predicting inpatient mortality is very challenging. Lacking standardized practices around end of life issues, hospitalists use their clinical judgment in making these crucial decisions. Prolonged discussions may be needed in medically complex patients to direct an optimal plan of care [...]

Background: Effective communication between health-care providers, patients and their families is a key aspect of the discussion surrounding a patient’s goals of care.  One crucial part of this process is reaching a shared understanding of how the patient views their own quality of life.   The objective of this study was to characterize factors patients and [...]

Background: Advance care planning is nationally recognized as important for honoring patient wishes at the end of life. Despite this widespread recognition, many patients lack advance care planning and spend their last days in ways not concordant with their values. Moreover, traditional advance directives may provide only a partial context for patients’ belief systems relevant [...]

Background: Hospitalists commonly discuss advance care planning (ACP), which supports patients in understanding and expressing their values for medical care during serious illness. The coronavirus disease of 2019 (COVID-19) pandemic has increased the urgency of these conversations, especially for patients with older age, comorbidities, or an otherwise high risk for complications such as ICU admission, [...]

Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple [...]

Background: Conducting early serious illness conversations (SICs) is a high-value intervention that improves the patient and family experience while aligning care with patient preferences. Given the constraints of hospital-based clinicians, using the EHR to identify appropriate patients for SICs remains a key challenge. The aims of this study were to explore whether the EHR’s readmission [...]

Background: Internal medicine residents face multiple barriers to participating in and documenting goals of care (GOC) meetings in the intensive care unit (ICU). Barriers include heavy workloads, need for urgent stabilization of critically ill patients, and inadequate communication skills training. Guidelines recommend regularly conducting and documenting GOC meetings for critically ill patients, to facilitate communication [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. Furthermore, in-hospital cardiopulmonary resuscitation (CPR) is associated with worse outcomes than intubation. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, [...]

Background: Hospital admission presents an important opportunity to engage with patients about goals of care (GOC) and advanced care planning. The significant and sensitive nature of GOC conversations requires that documentation of a patient’s goals be accurate, clear, and easily found in the medical record. This has become increasingly relevant in the setting of frequent [...]

Background: Several electronic health record (EHR) mortality prediction models have been developed to promote early goals of care discussions (GOCD) but only a few models were evaluated prospectively. We aimed to implement a real-time 30-day inpatient mortality prediction model previously developed at our facility and evaluate its effect on GOCD in seriously ill transferred patients. [...]