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The case for routine goals-of-care documentation
  1. Christopher Yarnell1,
  2. Robert Fowler1,2
  1. 1Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Canada
  2. 2Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Robert Fowler, Sunnybrook Health Sciences Centre, Room H468, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; rob.fowler{at}

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The article by Heyland et al1 reveals a 37% prevalence of discordance between patient preferences and hospital chart documentation for cardiopulmonary resuscitation (CPR) and other life-sustaining treatments. This high prevalence of discordance represents significant potential for avoidable, preventable harm. These findings demand that effective goals-of-care discussions and documentation should become as routine as eliciting and documenting medication allergies.

This study at 16 Canadian hospitals convincingly depicts inadequate documentation of goals of care. The authors calculated error rates using interviews with 500 hospitalised patients and 408 family members of hospitalised patients to learn their goals of care. They compared these goals with the documented goals of care in the patient orders and uncovered a 35% rate of potential overtreatment, defined as the proportion of patients who preferred to forego CPR while the chart lacked corresponding orders. The authors also measured a 2% rate of potential undertreatment, defined as the proportion of patients who preferred CPR while the chart had orders for no CPR. In other words, these patients would be at risk …

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