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

Details

• Personal Author:
  Hagiwara Y ; Miller DG ; Nugent AS ; Swanson MB ; Vakkalanka JP
• Description:
  Background: Historically, it has been assumed that the Emergency Department (ED) is a place for maximally aggressive care and that Emergency Medicine Providers (EMPs) are biased towards life-prolonging care. However, emphasis on early recognition of code status preferences is increasingly making the ED a venue for code status discussions (CSDs). In 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. We hypothesized that if EMPs enter CSDs with a bias toward life-prolonging care, or if the venue of the ED biases CSDs towards life-prolonging care, then we would observe a decrease in the percentage of patients selecting DNR status following our institution's aforementioned CSO mandate. 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 from the ED increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9), 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 can be an appropriate venue for CSDs. [Description provided by NIOSH]
• Subjects:
  Delivery Of Health Care Emergency Responders Health Promotion Occupational Health Safety
• Keywords:
  Advance Care Planning Author Keywords: Emergency Department Electronic Health Records Emergency Care Emergency Medicine Health Care Health Communications Medical Care Quality Improvement Resuscitation Orders
• ISSN:
  1049-9091
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Iowa ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  253-259
• Volume:
  38
• Issue:
  3
• NIOSHTIC Number:
  nn:20062635
• Citation:
  Am J Hosp Palliat Care 2021 Mar; 38(3):253-259
• Contact Point Address:
  Daniel G. Miller, MD, University of Iowa, 1008 RCP, 200 Hawkins Drive, Iowa City, IA 52242, USA
• Email:
  daniel-miller@uiowa.edu
• Federal Fiscal Year:
  2021
• Performing Organization:
  University of Iowa
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  The American Journal of Hospice and Palliative Medicine
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:65f6fa7db83d8fd8e7f86ca2d8fbb4c12d65548cf1b6b699e1288af4b7bde603627f9fc0bce19aaae4ae9cc46fefb6e27e7ee5a400993580738511748b817e57
• Download URL:
  https://stacks.cdc.gov/view/cdc/225840/cdc_225840_DS1.pdf
• File Type:
  [PDF - 223.34 KB ]