Abstract
IntroductionSome patients with end-stage disease who may neither want nor benefit from aggressive resuscitation receive such treatment if they cannot communicate in an emergency. Timely access to patients’ current resuscitation wishes, or “code status,” should be a key metric of electronic health records (EHR). We sought to determine what percentage of a cohort of patients with end-stage disease who present to the emergency department (ED) have accessible, code status documents, and for those who do, how quickly can this documentation be retrieved.MethodsIn this cross-sectional study of ED patients with end-stage disease (eg, palliative care, metastatic malignancy, home oxygen, dialysis) conducted during purposefully sampled random accrual times we performed a standardized, timed review of available health records, including accompanying transfer documents. We also interviewed consenting patients and substitute decision makers to compare available code status documents to their current wishes.ResultsCode status documentation was unavailable within 15 minutes of ED arrival in most cases (54/85, or 63%). Retrieval time was under five minutes in the rest, especially when “one click deep” in the EHR. When interviewed, 20/32 (63%) expressed “do not resuscitate” wishes, 10 of whom had no supporting documentation. Patients from assisted-living (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.7–26) and long-term care facilities (OR 13; 95% CI, 2.5–65) were more likely to have a documented code status available compared to those living in the community.ConclusionThe majority of patients with end-stage disease, including half of those who would not wish resuscitation from cardiorespiratory arrest, did not have code status documents readily available upon arrival to our tertiary care ED. Patients living in the community with advanced disease may be at higher risk for unwanted resuscitative efforts should they present to hospital in extremis. While easily retrievable code status documentation within the EHR shows promise, its accuracy and validity remain important considerations.
Highlights
Some patients with end-stage disease who may neither want nor benefit from aggressive resuscitation receive such treatment if they cannot communicate in an emergency
We sought to determine what percentage of a cohort of patients with end-stage disease who present to the emergency department (ED) have accessible, code status documents, and for those who do, how quickly can this documentation be retrieved
Code status documentation was unavailable within 15 minutes of ED arrival in most cases (54/85, or 63%)
Summary
Some patients with end-stage disease who may neither want nor benefit from aggressive resuscitation receive such treatment if they cannot communicate in an emergency. Decisions surrounding the resuscitation of a dying patient are complex and time pressured, yet are often made by emergency healthcare providers with incomplete or inaccurate information. Code Status Availability and Accuracy for ED Patients with End-stage Disease patients who present to the emergency department (ED) at the end of life are often so ill that they are unable to communicate their goals of care, including their code status,[7] or they lack the ability to make decisions about their care at the end of life.[8] In the absence of a readily available substitute decision maker (SDM), patients’ wishes for resuscitation are best obtained through code status documentation. The complexity and time pressure surrounding the high-stakes decision whether to withhold resuscitative efforts has increased with the COVID-19 pandemic.[9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
