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

Amirreza Sahebi-Fakhrabad, Eda Kemahlioglu-Ziya, Robert Handfield, Stacy Wood, Mehul D Patel, Cristen P Page, Lydia Chang
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Abstract

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.

院内代码状态更新:院内代码状态更新:随时间变化的趋势和 COVID-19 的影响。
目标:主要目的是评估创伤一级医院是否可以通过每日更新来减少代码状态文件缺失或不准确的患者比例。次要目标是研究在 COVID-19 大流行期间,患者对 DNR 的偏好是否发生了变化:这项回顾性研究的时间跨度为 2019 年 3 月至 2022 年 12 月,比较了两组数据中 ICU 和 ED 患者的代码状态。第一组数据基于历史电子病历(EHR),第二组数据涉及患者入院后的代码状态每日更新:结果:与急诊室相比,在重症监护室实施入院后每日更新能更有效地减少缺失的代码状态记录。在新系统下,约有 20% 没有具体代码状态的患者选择了 DNR。在 COVID-19 期间,观察到选择 DNR 的 ICU 患者有所减少,而选择完全代码 (FC) 的患者有所增加:本研究强调了定期更新和讨论代码状态对加强 ICU 和急诊室患者护理和资源分配的重要性。COVID-19 大流行影响了患者对完全代码状态的偏好,这凸显了适应性记录实践的必要性。强调对患者进行有关 DNR 意义和益处的教育是支持患者做出反映个人健康状况和价值观的知情决定的关键。这种方法将有助于平衡 DNR 和完全代码选择的考虑因素,尤其是在医疗危机期间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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