Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study

Jacobson, Eric S.; Troost, Jonathan P.; Epler, Katharine; Lenhan, Blair; Rodgers, Lily; O’Callaghan, Thomas; Painter, Natalia; Barrett, J. Carl

doi:10.1089/jpm.2022.0578

Cited by 2 publications

(3 citation statements)

References 36 publications

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“…This finding is in line with another study that also saw fewer people choosing limited resuscitation options as the pandemic went on. 5 However, they only studied patients hospitalized with COVID-19 while our data set consists of all patients in the ICU and ED.…”

Section: Discussionmentioning

confidence: 99%

“…Although our study did not directly investigate these hypotheses, the data suggests that the pandemic context played a role in shaping patient choices. 5 It is important to highlight that proactive advance care planning and early detection of DNR preferences remain crucial, especially for patients with serious illnesses like COVID-19. 21,22 However, our findings suggest that in the unique circumstances of a health care crisis such as a pandemic, patients' inclinations towards code status decisions, specifically DNR, may shift.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Patients in the United States, where our study was conducted, can express their treatment preferences through different code status options-Full Code (FC), Do Not Resuscitate (DNR), DNR and Do Not Intubate (DNI), or Limited Code (LC). 5 At the hospital system where our data was collected, there are 5 preset options for limited code (no chest compressions, no defibrillation/cardioversion, no internal/external pacemaker, no drug protocol after arrest occurs, no mechanical ventilation with intubation) or the patient may specify their requests. At The Patient Self Determination Act of 1990 encourages patients to document their medical intervention preferences.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

In-Hospital Code Status Updates: Trends Over Time and the Impact of COVID-19

Sahebi-Fakhrabad,

Kemahlioglu-Ziya,

Handfield

et al. 2023

Am J Hosp Palliat Care

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Objective The primary objective was to evaluate if the percentage of patients with missing or inaccurate code status documentation at a Trauma Level 1 hospital could be reduced through daily updates. The secondary objective was to examine if patient preferences for DNR changed during the COVID-19 pandemic. Methods This retrospective study, spanning March 2019 to December 2022, compared the code status in ICU and ED patients drawn from two data sets. The first was based on historical electronic medical records (EHR), and the second involved daily updates of code status following patient admission. Results Implementing daily updates upon admission was more effective in ICUs than in the ED in reducing missing code status documentation. Around 20% of patients without a specific code status chose DNR under the new system. During COVID-19, a decrease in ICU patients choosing DNR and an increase in full code (FC) choices were observed. Conclusion This study highlights the importance of regular updates and discussions regarding code status to enhance patient care and resource allocation in ICU and ED settings. The COVID-19 pandemic’s influence on shifting patient preferences towards full code status underscores the need for adaptable documentation practices. Emphasizing patient education about DNR implications and benefits is key to supporting informed decisions that reflect individual health contexts and values. This approach will help balance the considerations for DNR and full code choices, especially during health care crises.

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Section: Discussionmentioning

confidence: 99%