Code status orders in patients admitted to the intensive care unit with COVID-19: A retrospective cohort study

Moin, Emily E.; Okin, Daniel; Jesudasen, Sirus; Dandawate, Nupur; Gavralidis, Alexander; Chang, Leslie; Witkin, Alison S.; Hibbert, Kathryn A.; Kadar, Aran; Gordan, Patrick L.; Bebell, Lisa M.; Lai, Peggy S.; Alba, George A.

doi:10.1016/j.resplu.2022.100219

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…17,18 Future studies should consider investigating how code status discussions should adapt to patient characteristics, such as language proficiency. 19,20 We observed that fewer ICU patients with no specific code (NS) switched to "Do Not Resuscitate" (DNR) code during and after the COVID-19 pandemic. This finding is in line with another study that also saw fewer people choosing limited resuscitation options as the pandemic went on.…”

Section: Discussionmentioning

confidence: 99%

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%

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

View full text Add to dashboard Cite

show abstract

“…Since the start of the pandemic, hospitals have observed a significant rise in the percentage of patients with LEP or requesting interpreter services [30,31]. During the COVID-19 pandemic, patients with LEP at the end-of-life were more likely to be Full Code and die after longer hospital stays [32,33]. The serious nature of COVID-19 and associated high morbidity and mortality rates resulted in clinicians more frequently encountering scenarios that are at high risk of misunderstanding without professional interpretation, such as end-of-life and goals-of-care discussions [34].…”

Section: Introductionmentioning

confidence: 99%

Strategies Used by Healthcare Systems to Communicate with Hospitalized Patients and Families with Limited English Proficiency During the COVID-19 Pandemic: A Narrative Review

Yang

Prokop

Barwise

2023

J Immigrant Minority Health

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The COVID-19 pandemic disproportionately affected racial and ethnic minorities in the United States, including many with limited English proficiency (LEP). These patients face various communication barriers, including a shortage of available interpreters and the need for masks that exacerbated communication barriers. It is not known how hospitals responded to these unique challenges to providing language services for the large number of patients with LEP during COVID-19. This narrative review assessed literature and lay media to identify strategies utilized by hospitals to communicate with patients with LEP hospitalized during the COVID-19 pandemic. A search of APA PsychInfo, EBM Reviews, Embase, Ovid MEDLINE, Epub Ahead of Print, and Ebsco Megafile initially yielded 61 articles, 6 of which were ultimately included after reviewing abstracts and full texts. The identified interventions, which sought to increase accessibility of language-concordant care, increase accessibility of professional interpretation, and improve family communication and understanding, were described positively, though only one was tested for effectiveness.

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“…Additionally, ICU patients with a preferred language other than English have been found to be less likely to have a DNR order. [13] However, no study to date has looked at a broader range of social determinants on all admitted patients and how they might impact COVID-19 patients code status.…”

Section: Introductionmentioning

confidence: 99%

Evaluating disparities in code status designation among patients admitted with COVID-19 at a quaternary care center early in the pandemic

et al. 2023

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The COVID-19 pandemic has highlighted disparities in outcomes by social determinants to health. It is unclear how much end-of-life discussions and a patient’s decision about code status (“do not resuscitate,” do not resuscitate, or “comfort measures only,” [CMO] orders) might contribute to in hospital disparities in care, especially given know racial inequities in end-of-life care. Here, we looked at factors associated with code status orders at the end of hospitalization for patients with COVID-19. We conducted a retrospective chart review of all patients who presented to the Emergency Department of a large quaternary hospital between 8 March and 3 June 2020. We used logistic regression modeling to quantify the degree to which social determinants of health, including race, ethnicity, area deprivation index (ADI), English as a primary language, homelessness, and illicit substance use might impact the likelihood of a particular code status at the end-of a patient’s hospitalization, while controlling for disease severity. Among social determinants to health, only white race (odds ratio [OR] 2.0; P = .03) and higher ADI (OR 1.2; P = .03) were associated with having a do not resuscitate or a CMO order. Additionally, we found that patients with white race (OR 2.9; P = .02) were more likely to carry a CMO order. Patient race and ADI were associated with different code status orders at the end of hospitalization. Differences in code status might have contributed to disparities in COVID-19 outcomes early in the pandemic, though further investigations are warranted.

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Code status orders in patients admitted to the intensive care unit with COVID-19: A retrospective cohort study

Cited by 8 publications

References 45 publications

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

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

Strategies Used by Healthcare Systems to Communicate with Hospitalized Patients and Families with Limited English Proficiency During the COVID-19 Pandemic: A Narrative Review

Evaluating disparities in code status designation among patients admitted with COVID-19 at a quaternary care center early in the pandemic

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