Is the Emergency Department an Inappropriate Venue for Code Status Discussions?

Details

• Alternative Title:
  Am J Hosp Palliat Care
• Personal Author:
  Miller, Daniel G. ; Vakkalanka, J. Priyanka ; Swanson, Morgan B. ; Nugent, Andrew S. ; Hagiwara, Yuya
• Description:
  Background:
  
  An emphasis on early recognition of code status preferences is increasingly making Emergency Departments (ED) a venue for code status discussions (CSDs). Historically, it has been assumed that the ED is a place for maximally aggressive care and Emergency Medicine Providers (EMPs) have a proclivity towards life-prolonging care. In April 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. Holding the historical assumptions of the ED & EMPs as true, we hypothesized that the proportion of patients who would select do not resuscitate (DNR) would decrease after requiring CSDs with EMPs for all admissions.
  
  Methods:
  
  We present a retrospective analysis of rates of DNR orders placed for patients admitted through our ED comparing six-month periods before and after the implementation of the above policy.
  
  Results:
  
  Using quality improvement data, we identified patients admitted through the ED during pre (n=7,858) and post (n=8,069) study periods. We observed the following: after implementation DNR preference identified prior to hospital admission increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9) in the ED, defining CS in the ED setting at the time of admission increased from 2.4% to 98.6% (p <0.001), and DNR orders placed during inpatient admission was unchanged (RR=0.97 (95% CI = 0.88-1.07)).
  
  Discussion:
  
  Our results suggest that the ED may be an appropriate venue for CSDs.
  
  
• Subjects:
  Advance Care Planning Article Electronic Health Records Emergency Department Emergency Medicine Quality Improvement Resuscitation Orders
• Source:
  Am J Hosp Palliat Care. 38(3):253-259
• Pubmed ID:
  32613837
• Pubmed Central ID:
  PMC7775892
• Document Type:
  Journal Article
• Funding:
  T32 GM007337/GM/NIGMS NIH HHS/United States ; T42 OH008491/OH/NIOSH CDC HHS/United States
• Volume:
  38
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:485f3dab1c7010be3c005170e3fd896896dc0620a66a448477b31e17ca280d34
• Download URL:
  https://stacks.cdc.gov/view/cdc/104172/cdc_104172_DS1.pdf
• File Type:
  [PDF - 143.37 KB ]