PURPOSE: This study measured code status and advance directive documentation among residents before and after an educational intervention.
METHODS: We evaluated 2,000 total consecutive admissions to the Internal Medicine service at the Community Regional Medical Center, Fresno, California. The three time periods were the observational (July 1, 2006 to October 2006: 1,000 patients), the interventional period, and the second observational period (July 1 2009 to December 2009; 1,000 patients). During the interventional period the program introduced 5 new lectures. We also created 6 "Ethics Case Presentation Conferences." We also provided education to the attending physicians.
RESULTS: During the first observational period the residents documented a total of 105/1000 (10.5%) code status discussions on the date they admitted their patient to the hospital. During the second observational period the residents documented 491/1000 (49.1%; p value < 0.001) code status discussions, a 38.6% improvement. The patient’s code status choice during the first observational period was Full Code for 102/1000 (10.2%), DNR/DNI or DNI or DNR ok to intubate 68/1000(6.8%) Comfort Care or Palliative care only 3/1000 (0.3%). During the second observational period the patient’s code status choice was Full Code for 435/1000 (43.5%; p value < 0.001), DNR/DNI or DNI or DNR ok to intubate 57/1000(5.7%; p value=0.310, nonsignificant) Comfort Care or Palliative care only 3/1000 (0.3%; p value=1, nonsignificant).
CONCLUSION: We were able to significantly improve the documentation of code status discussions when patients were admitted to our hospital. We found that the overall percentages of patients requesting Full Code status was much higher in the second observational period, while the patients which requested DNR/DNI or DNI or DNR ok to intubate and Comfort Care or Palliative care percentage remained almost exactly the same.
CLINICAL IMPLICATIONS: This study provides some successful methods that teaching programs can use to improve resident documentation of code status or advance directives discussions.
DISCLOSURE: Garrett Bird, No Financial Disclosure Information; No Product/Research Disclosure Information