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

Abstract

ABSTRACTBackgroundConversion 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 this may have been further impacted by the COVID‐19 pandemic.AimsTo determine the impact of EMR and COVID‐19 on the proper completion of GOC forms and the factors associated with inpatient changes in GOC.MethodsWe conducted a cross‐sectional study of adult general medicine admissions (August 2018–September 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 the arrival of COVID‐19.ResultsWe 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% confidence interval (CI): −2.83 to −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 to 3.15) compared with the EMR period, but also resulted in a higher proportion of GOC changes within 2 days of admission.ConclusionsEMR 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.