SummaryBackground: Alcohol use is a significant part of a patient's history, but details about consumption are not always documented. Electronic Health Record (EHR) systems have the potential to improve assessment of alcohol use and misuse; however, a challenge is that critical information may be documented primarily in free-text rather than in a structured and standardized format, thereby limiting its use. Objective: To characterize the use and contents of free-text documentation for alcohol use in the social history module of an EHR. Methods: This study involved a retrospective analysis of 500 alcohol use entries that include structured fields as well as a free-text comment field. Two coding schemes were developed and used to analyze these entries for: (1) quantifying the reasons for using free-text comments and (2) categorizing information in the free-text into separate elements. In addition, for entries indicating possible alcohol misuse, a preliminary review of other structured parts of the EHR was conducted to determine if this was also documented elsewhere. Results: The top three reasons for using free-text were limited ability to describe alcohol use frequency (75%), amount (22%), and status (18%) with available structured fields. Within the freetext, descriptions of frequency were most common (79%) using words or phrases conveying occasional (61%), daily (13%), or weekly (12%) use. Of the 36 cases suggesting alcohol misuse, 44% had mention of alcohol problems in the problem list or past medical history. Conclusions: Based on the early findings, implications for improving the structured collection and use of alcohol use information in the EHR are provided in four areas: (1) system enhancements, (2) user training, (3) decision support, and (4) standards. Next steps include examining how alcohol use is documented in other parts of the EHR (e.g., clinical notes) and how documentation practices vary based on patient, provider, and clinic characteristics. An Analysis of Free-Text Alcohol Use Documentation in the Electronic BackgroundThe lifetime prevalence of alcohol use disorders is approximately 30% in the United States and costs the nation nearly $224 billion a year [1,2]. Chronic alcohol abuse and dependence not only lead to debilitating medical conditions such as liver cirrhosis, Wernicke-Korsakoff syndrome, fetal alcohol syndrome, and alcoholic cardiomyopathy, but can also contribute to traffic accidents, violence, suicide, and crime [3]. Though alcohol use is a significant part of a patient's history, details about alcohol consumption are not always documented in the health record [4,5]. In one study, older patients with undocumented alcohol abuse issues were found to be more likely to be hospitalized and have higher mortality rates [6]. Having an accurate picture of each patient's alcohol use-past and present-is essential for clinicians to provide the best care.The latest recommendation by the U.S. Preventive Services Task Force is to screen adults and provide brief behavioral counseling interventio...

Background: Several months into the COVID-19 pandemic, reassessing intensive care unit (ICU) utilization, specifically with regional impact on diverse populations, should be a priority for hospitals planning for critical care resource allocation. In our study, we reviewed the impact of COVID-19 on a community hospital serving an urban region, comparing the sociodemographic distribution of ICU admissions before and during the pandemic. Methods: We executed a time sensitive analysis to see if COVID-19 ICU admissions reflect regional sociodemographic populations as well as ICU admission trends prior to the current pandemic. Collected sociodemographic variables included sex, race, ethnicity, and age of adult patients (age 18 and older) admitted to the hospital’s medical and cardiac ICUs, which were converted to COVID-19 ICUs. The time period selected was 18-months, which was then dichotomized into pre-COVID-19 admissions (December 1, 2018 to March 13, 2020) and COVID-19 ICU admissions (March 14, 2020 to May 31, 2020). Variables were compared using Fisher’s exact tests and Wilcoxon tests when appropriate.Results: During the 18-month period, 1861 patients were admitted to the aforementioned ICUs. The mean age of the 1861 patients was 62.75 + 15.57 years old, with the majority of these patients being male (52.23%), White (64.43%), and non-Hispanic/Latinx (95.75%). There were differences in racial and ethnic distribution comparing pre-COVID-19 admissions to the COVID-19 admissions. Compared to pre-COVID-19 ICU admissions, there was an increase in African American versus White admissions (p=0.01) and an increase in Hispanic/Latinx versus non-Hispanic/Latinx admissions (p<0.01), during the COVID-19 pandemic.Discussion: During the first three months of admissions to COVID-19 ICUs, there was a rise in admissions among Hispanic/Latinx and African-American patients, while non-Hispanic/Latinx and White patient admissions declined compared to the previous pre-COVID year. These findings support development of strategies to enhance allocation of resources to bolster novel, equitable strategies to mitigate the incidence of COVID-19 in minority populations.