"Reading between the lines" of flow sheet data: nurses' optional documentation associated with cardiac arrest outcomes.

Historically, short ‘comments’ on paper-based flowsheets conveyed the patient's overall clinical state. We analyzed the content and documentation patterns of electronic health record flowsheets for 201 cardiac arrest patients. Free-text comments were associated with the abnormality of clinical measurements (p<0.05). The documentation of 3 or more comments for acute care patients was associated with a greater likelihood of dying by discharge (p<0.01). Documentation of ICU vital signs greater than the minimum hourly requirement was associated with increased survival of a cardiac arrest (p<0.05). Further analysis of such patterns may be useful for the measurement of nursing knowledge and surveillance activities, interdisciplinary communication tools, and clinical decision making.