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International Journal for Quality in Health Care 16:333-335 (2004)
International Journal for Quality in Health Care vol. 16 no. 4 © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved

Evaluation of a labeling system to indicate the presence of an advance directive in a hospital medical record

James Wallace1 and Norman A. Desbiens2

1 University of North Carolina, School of Public Health, Chapel Hill, NC, 2 University of Tennessee College of Medicine, Chattanooga Unit, Department of Internal Medicine, Chattanooga, TN, USA

Objective. To investigate the accuracy of one hospital’s system to indicate whether an advance directive exists within a patient’s medical record.

Design. Medical record review while patients were hospitalized.

Setting. Internal medicine residency program within a tertiary care hospital.

Study participants. Patients admitted to four internal medicine services between 25 October 2000 and 6 December 2000.

Main outcome measures. Presence of an advance directive and a label in medical records were recorded, along with patient demographics, and sensitivity, specificity, and accuracy were calculated.

Results. Four of 125 medical records (3%) contained advance directives. Sensitivity of a label for an advance directive was 25% [95% confidence interval (CI) 1–81%], specificity was 62% (95% CI 53–71%), and accuracy was 61% (95% CI 52–69%).

Conclusions. Use of the hospital’s labeling system to indicate the presence of advance directives was found to be highly inaccurate. Failure to correctly follow or understand the intended labeling procedure was the most likely source of error. Hospitals should include plans to check the accuracy of protocols when they are adopted to ensure that they are performing as intended.

Keywords: advance directives, continuous quality improvement, hospital systems, medical records

Address reprint requests to Norman A. Desbiens, University of Tennessee College of Medicine, Chattanooga Unit, Department of Internal Medicine, Chattanooga, TN, USA. E-mail: desbiena{at}erlanger.org or naylordc{at}erlanger.org

Accepted for publication March 22, 2004.


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