An Electronic Health Record-Assisted Patient Safety Intervention to Identify Missing Code Status Orders in Patients with Prior Do-not-Attempt-Resuscitation or Partial Code Status

Abstract

Background:

Hospitalized patients with serious illnesses often lack code status documentation, increasing the risk of goal-discordant care during hospitalization.

Local Problem:

Patients with a prior preference for do-not-attempt-resuscitation (DNAR) sometimes lacked a code status order during subsequent encounters, creating a patient safety risk of undesired resuscitation in the event of cardiac arrest.

Intervention:

In May 2025, we developed an electronic health record (EHR) alert to prompt code status discussion for hospitalized medicine patients with prior DNAR or partial code.

Methods:

We compared the proportion of patients with active code status during admission and timing of order before and after intervention.

Results:

Of 713 patients with prior DNAR or partial code status, the percentage with an active code status order increased following implementation (96.4% vs. 89.6%, p < 0.001). Only 6.1% of code status orders were placed within five minutes of alert. Median time from admission to first order increased post-implementation (eight vs. seven hours, p = 0.03).

Conclusions:

An EHR alert to prompt code status discussions in patients with prior DNAR or partial code status increased code status order documentation. Further studies could explore expanding alerts to other services and assessing impact on goal-concordant care.