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Is the Emergency Department an Inappropriate Venue for Code Status Discussions?
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July 02 2020
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Source: Am J Hosp Palliat Care. 38(3):253-259
[PDF-143.37 KB]
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Alternative Title:Am J Hosp Palliat Care
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Personal Author:
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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.
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Pubmed ID:32613837
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Pubmed Central ID:PMC7775892
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