Abstract WP286: Code Status Prior to Admission Dose Not Influence Timing of Transition to Inpatient Hospice in Devastating Stroke

Abstract

Background: The transition of care from an aggressive disease-directed plan to comfort focused hospice care is a difficult choice for patients with devastating stroke and their family members particularly in the absence of advance directives. However, it is not clear if preexisting Do Not Resuscitate (DNR) status influences the timing of this decision. Objectives: To evaluate factors associated with transfer time to hospice for patients with devastating stroke and, particularly, the influence of defined code status prior to admission. Methods: A retrospective analysis of patients with stroke admitted to inpatient hospice from January 2013-December 2014 at our institution was conducted yielding 71 patients. The group was dichotomized to those with a preexisting DNR (n=19) or not (n=52). Clinical variables and sociodemographic factors were collected and compared using chi-square tests of proportion and t-tests for independent groups. Specifically, median time from admission to inpatient hospice for both groups was compared using a Wilcoxon Ranked Sum test set at 0.05 to test statistical significance. Results: For all patients, the mean age was 82.01 +/- 9.64 years, 60.6% female and 84.5% Caucasian. Approximately 66% of strokes were ischemic and 34% hemorrhagic with a mean NIH score of 21.45 +/- 6.03. Age (83.7 +/- 9.8 vs. 81.4 +/- 9.6; p=0.377 ), ethnicity (% Caucasian: 84.2 vs. 84.6; p= 0.967 ), stroke subtype (% ischemic: 73.7 vs. 61.5; p= 0.343 ), severity (NIH: 21.2 +/- 8.8 vs. 20.9 +/- 4.6; p=0.852 ), insurance status (% Medicare Plus: 73.7 vs. 57.7; p=0.219 ), history of prior stroke (26.3% vs. 23.1%; p=0.777 ), dementia (21.1% vs. 28.9%; p=0.511 ), malignancy (10.53% vs. 13.46%; p=0.742 ), and living arrangement (% living with family: 73.7 vs. 51.9; p=0.132 ) were not statistically different in the DNR and no DNR cohorts respectively. The median time from admission to inpatient hospice for preexisting DNR vs. no DNR did not differ (3.0 vs. 4.5 days ; p=0.176 ). Conclusion: In our study, there were no significant factors, including preexisting DNR status, that influenced transition time to inpatient hospice. Code status on admission is not an indicator of goals of care. Future studies are needed to validate these findings