Code Status Decisions: Did the Pandemic Change Patients’ and Families’ Preferences? (S519)

Abstract

Outcomes1. Understand influence of a public health emergency on goal-concordant hospital care based on pre-admission treatment preferences2. Recognize the critical role of palliative care in navigating goal-concordant care for seriously ill patients hospitalized during the pandemicOriginal Research BackgroundOne measure of goal-concordant care is whether patients’ informed decisions on code status are honored. Public health emergencies, such as the COVID-19 pandemic, may create an environment of fear and confusion that could influence prior treatment decisions upon hospitalization.Research ObjectivesEvaluate whether code status decisions on preadmission Massachusetts Orders on Life Sustaining Treatment (MOLST) orders matched the admission orders to acute care units during first surge of the COVID-19 pandemic.MethodsWe did a retrospective chart review of patients admitted with severe COVID-19 infection and seen by the palliative care (PC) team between March and May 2020 at a tertiary care center in Massachusetts. The charts were evaluated for presence or absence of MOLST forms before admission, code status decisions on these MOLST forms and initial admission orders, and changes to code status after PC consult.ResultsThe PC team had 92 patient encounters during the span of 2 months. 52 patient charts (57%) had a pre-admission MOLST form; among these, 24 patients had elected DNR/DNI, 2 elected DNR only, and 25 elected full code. Of note, 4/24 patients with DNR/DNI preference also had “do not hospitalize” orders. On admission, most prior DNR/DNI decisions carried forward except for 5 patients (3 changed to DNR only and 2 to full code). Most prior decisions for full code carried forward except for 7 patients, as limitations were added after goals-of-care discussions between families and frontline clinicians. After PC consult, 7/92 encounters had limitations of DNI/DNR or DNR only.ConclusionOur study demonstrated that most clinicians, patients, and families honored prior code status decisions, made by seriously ill patients and their surrogates, during the pandemic. This study sheds light on the critical role of MOLST/POLST in frontline goals-of-care conversations and the indispensable role of PC specialists during a public health emergency.Implications for Research, Policy, or PracticeThis study may inform further acceptance of MOLST/POLST to document patient preferences.