With the growth of Rapid Response Teams in the hospital setting, a patient's primary physician is now rarely the first to respond to a medical emergency or cardiac arrest. Protecting patient safety and autonomy necessitates discussion of resuscitation goals with patients upon admission and documentation of these conversations appropriately. We hypothesized that a standardized form would improve rates of code status discussions and the quality of physician documentation in the medical record.
A prospective trial was performed over two consecutive 28-day periods. The study population consisted of all new admissions to the Medical (MICU), Surgical (SICU), and Neurosurgical (NSICU) Intensive Care Units, and Medicine, Surgery and Neurology wards. Data collected included demographics, co-morbid conditions, admission laboratory values, and Simplified Acute Physiology Score (SAPS II) and Charlson Index Scores. After an initial 28-day observation period, a standardized code status form was introduced and physicians oriented to its use. To assess effectiveness, the following were recorded for both study periods: the presence of code status note in the medical record, presence of a matching order in the electronic medical record (EMR), and completeness of the note. Student's t or chi square tests were used where appropriate. P<0.05 was considered significant.
Records from 996 patient admissions were evaluated, 494 before and 492 after intervention. There were no differences between the two study periods in terms of patient demographics or predictors of survival measured by SAPS II score & Charlson Index. Introduction of a standardized form increased code status documentation: 165/494 (33.4%) before vs. 230/492 (46.7%) after the standardized form (p<0.001). EMR order rates were low but improved with the standardized form [4/494 (0.8%) vs. 64/492 (13%); p<0.001], as did completeness of the code status note (p<0.001 for all data points).
Introduction of a standardized form improved the rate and quality of code status documentation in the medical record.
A standardized form enhances code status documentation and may help physicians assess more thoroughly a patient's goals of care.
Emily Rehberg, No Financial Disclosure Information; No Product/Research Disclosure Information