290 Usability and Acceptability of a Brief Tool to Guide Code Status Conversations in the Emergency Department

Abstract

Emergency medicine (EM) resident physicians frequently have difficult conversations with patients regarding goals of care, such as choices around code status. However, many surveyed EM residents report feeling uncomfortable having these conversations. The “Best Case / Worst Case” tool was developed in 2015 to help guide surgeons in discussing care options with patients, but its use by EM providers has not been studied. Our goal was to assess the usability and acceptability of this tool for EM providers. EM residents and faculty in one US EM residency were invited to attend a two-hour session held during the weekly residency conference, during which they were introduced to the “Best Case / Worst Case” tool through a video and presentation based on curriculum made by the tool’s creators. Attendees then tried utilizing the tool themselves, under the guidance of EM and palliative medicine providers, through sample cases. Afterwards, attendees had the option to a voluntary and anonymous survey, either in-person or online, and results were summarized and analyzed. Twenty-seven (27) providers attended the interactive session and twenty-three (23) filled out surveys afterwards. The results are summarized in Table 1. Overall, respondents viewed the “Best Case / Worst Case” tool positively, responding that they felt the tool would benefit patients (82.6%, 19 / 23), lead to improved use of resources while helping severely ill patients (73.3%, 11 / 15), and felt it would be a reliable tool (83.3%, 15 / 18). Additionally, most respondents indicated this tool was better than their usual approach (72.2%, 13 / 18), and that they would feel more comfortable having a Code Status conversation using this tool (77.8%, 14 / 18). After a brief educational session, the “Best Case / Worst Case” tool was described by EM providers as both usable and acceptable. Further study of this and other tools to aid EM providers in leading goals of care conversations is indicated.