Adina S Weinerman1, Irfan A Dhalla2,3,4,5, Alex Kiss5, Edward E Etchells1,2, Robert C Wu2,6, Brian M Wong1,2,7. 1. Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 4. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 5. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada. 6. Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada. 7. Centre for Quality Improvement and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Accurate and complete documentation of hospitalized patients' code status is important to ensure that healthcare providers take appropriate action in the event of a cardiac arrest. OBJECTIVE: Determine the frequency and clinical relevance of incomplete and inconsistent code status documentation. DESIGN: Point-prevalence study. SETTING: Academic medical centers. PATIENTS: Patients admitted to general internal medicine wards. MEASUREMENTS: Frequency and clinical relevance of inconsistent code status documentation across 5 documentation sources. RESULTS: Thirty-eight (20%; 95% confidence interval [CI], 14%-26%) of 187 patients had complete and consistent code status documentation. Another 27 (14%; 95% CI, 9%-19%) patients had no code status documentation. The remaining 122 (65%; 95% CI, 58%-72%) patients had at least 1 code status documentation inconsistency. Of these, 38 (20%; 95% CI, 14%-26%) patients had a clinically relevant code status documentation inconsistency. Multivariate logistic regression analysis demonstrated that increased age (odds ratio [OR] = 1.07 [95% CI, 1.05-1.10] for every 1-year increase in age, P < 0.001) and patients receiving comfort measures (OR = 9.39 [95% CI, 1.35-65.19], P = 0.02) were independently associated with a clinically relevant code status documentation inconsistency. CONCLUSIONS: Incomplete and inconsistent documentation of code status occurred frequently in hospitalized patients, especially elderly patients and patients receiving comfort measures. Having multiple, poorly integrated code status documentation sources leads to a significant number of concerning inconsistencies that create opportunities for healthcare providers to inappropriately deliver or withhold resuscitative measures that conflict with patients' expressed wishes. Institutions need to be aware of this potential documentation hazard and take steps to minimize code status documentation inconsistencies.
BACKGROUND: Accurate and complete documentation of hospitalized patients' code status is important to ensure that healthcare providers take appropriate action in the event of a cardiac arrest. OBJECTIVE: Determine the frequency and clinical relevance of incomplete and inconsistent code status documentation. DESIGN: Point-prevalence study. SETTING: Academic medical centers. PATIENTS: Patients admitted to general internal medicine wards. MEASUREMENTS: Frequency and clinical relevance of inconsistent code status documentation across 5 documentation sources. RESULTS: Thirty-eight (20%; 95% confidence interval [CI], 14%-26%) of 187 patients had complete and consistent code status documentation. Another 27 (14%; 95% CI, 9%-19%) patients had no code status documentation. The remaining 122 (65%; 95% CI, 58%-72%) patients had at least 1 code status documentation inconsistency. Of these, 38 (20%; 95% CI, 14%-26%) patients had a clinically relevant code status documentation inconsistency. Multivariate logistic regression analysis demonstrated that increased age (odds ratio [OR] = 1.07 [95% CI, 1.05-1.10] for every 1-year increase in age, P < 0.001) and patients receiving comfort measures (OR = 9.39 [95% CI, 1.35-65.19], P = 0.02) were independently associated with a clinically relevant code status documentation inconsistency. CONCLUSIONS: Incomplete and inconsistent documentation of code status occurred frequently in hospitalized patients, especially elderly patients and patients receiving comfort measures. Having multiple, poorly integrated code status documentation sources leads to a significant number of concerning inconsistencies that create opportunities for healthcare providers to inappropriately deliver or withhold resuscitative measures that conflict with patients' expressed wishes. Institutions need to be aware of this potential documentation hazard and take steps to minimize code status documentation inconsistencies.
Authors: Jessica Ma; Stephen Chi; Benjamin Buettner; Katherine Pollard; Monica Muir; Charu Kolekar; Noor Al-Hammadi; Ling Chen; Marin Kollef; Maria Dans Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598
Authors: Monica Escher; Stéphane Cullati; Patricia Hudelson; Mathieu Nendaz; Bara Ricou; Thomas Perneger; Pierre Dayer Journal: Health Serv Res Date: 2018-10-25 Impact factor: 3.402
Authors: Alexandria J Robbins; Nicholas E Ingraham; Adam C Sheka; Kathryn M Pendleton; Rachel Morris; Alexander Rix; Victor Vakayil; Jeffrey G Chipman; Anthony Charles; Christopher J Tignanelli Journal: J Pain Symptom Manage Date: 2020-09-17 Impact factor: 3.612