Browsing by Subject "Code status"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    No More Resuscitation a la Carte: Towards a Universal, Simple, Ethical, and Medically Sound Code Status Ordering
    (Wolters Kluwer, 2023-03-27) Al Faiyumi, Mohammed; Medicine, School of Medicine
    Cardiopulmonary resuscitation is a commonly performed intervention in clinical medicine and determining a patient’s code status is paramount. “Limited/partial code” has crept into medical practice throughout the years and has become an acceptable practice. We describe here a tiered, clinically sounds and ethical code status ordering that includes the main elements of resuscitation, helps with establishing goals of care, eliminates the use of “limited/partial code,” facilitates shared decision-making with patients and surrogates and is easy to communicate to healthcare team members.