Browsing by Author "Schmidt, Amanda"

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    Code status orders in hospitalized patients with COVID-19
    (Elsevier, 2023-08-23) Comer, Amber R.; Fettig, Lyle; Bartlett, Stephanie; Sinha, Shilpee; D’Cruz, Lynn; Odgers, Aubrey; Waite, Carly; Slaven, James E.; White, Ryan; Schmidt, Amanda; Petras, Laura; Torke, Alexia M.; Medicine, School of Medicine
    Background: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19. Methods: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020). Results: Among 1375 hospitalized patients with COVID-19, 19% (n = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) p =< 0.01, OR 1.12 and hospitalization early in the pandemic p = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts p => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, p = 0.80. Conclusions: There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.
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    Prevalence, Predictors and Outcomes of Documented DNR and/or DNI Orders in COVID-19 Patients (S522)
    (Elsevier, 2022) Comer, Amber; Fettig, Lyle; Bartlett, Stephanie; Schmidt, Amanda; Endris, Katelyn; Zepeda, Isabel; Waite, Carly; Slaven, James; Torke, Alexia; Medicine, School of Medicine
    Outcomes: 1. Understand the prevalence, predictors, and outcomes associated with DNR and DNI orders for hospitalized patients with COVID-19 throughout the pandemic 2. Understand the reasons for differences in code status order utilization for hospitalized patients with COVID-19 throughout the pandemic Original Research Background: The COVID-19 pandemic created complex challenges regarding timing and appropriateness of do not resuscitate (DNR) and do not intubate (DNI) orders. Research Objectives: This study sought to determine the prevalence, predictors, timing, and outcomes associated with having a documented DNR or DNI order for hospitalized patients with COVID-19. Methods: A retrospective multisite chart review of hospitalized patients with COVID-19 was performed to determine characteristics, medical treatments received, and outcomes associated with having a documented DNR or DNI order. Patients were divided into two cohorts (early and late) by timing of hospitalization during the pandemic. Results: Among 1,358 hospitalized patients with COVID-19, 19% (n = 259) had a documented DNR or DNI order. In multivariate analysis, age (older) (p < .01, OR 1.13), race (White) (p = .01, OR 0.55), and hospitalization during the early half of the pandemic (p = .02, OR 1.8) were associated with having a DNR or DNI order. Palliative care consultation occurred more often in the early cohort (p < .01). Medical treatments, including ICU (p = .31) and level of ventilator support (p = .32) did not differ between cohorts. Hospital mortality was similar between the early and late cohorts (p = .27); however, among hospital decedents median hospital day from DNR or DNI order to death differed between cohorts (p < .01) (6 days from order to death in early vs 2 days in the late cohort). Conclusion: More frequent use of DNR orders and orders written farther from death in decedents characterized the early pandemic phase. White patients were more likely to have DNR or DNI orders, consistent with prior research. Implications for Research, Policy, or Practice: Uncertainty in prognosis may have played a role in the frequency and timing of DNR and DNI orders early in the pandemic. Additional factors, such as fear of resource shortage and transmission of COVID-19 to healthcare workers, may have also played a role.