Journal article
Code status orders and goals of care in the medical ICU
Chest, Vol.139(4), pp.802-809
04/2011
DOI: 10.1378/chest.10-1798
PMCID: PMC3198491
PMID: 21292755
Abstract
Decisions about CPR in the medical ICU (MICU) are important. However, discussions about CPR (code status discussions) can be challenging and may be incomplete if they do not address goals of care.
We interviewed 100 patients, or their surrogates, and their physicians in an MICU. We queried the patients/surrogates on their knowledge of CPR, code status preferences, and goals of care; we queried MICU physicians about goals of care and treatment plans. Medical records were reviewed for clinical information and code status orders.
Fifty patients/surrogates recalled discussing CPR preferences with a physician, and 51 recalled discussing goals of care. Eighty-three patients/surrogates preferred full code status, but only four could identify the three main components of in-hospital CPR (defibrillation, chest compressions, intubation). There were 16 discrepancies between code status preferences expressed during the interview and code status orders in the medical record. Respondents' average prediction of survival following in-hospital cardiac arrest with CPR was 71.8%, and the higher the prediction of survival, the greater the frequency of preference for full code status (P = .012). Of six possible goals of care, approximately five were affirmed by each patient/surrogate and physician, but 67.7% of patients/surrogates differed with their physicians about the most important goal of care.
Patients in the MICU and their surrogates have inadequate knowledge about in-hospital CPR and its likelihood of success, patients' code status preferences may not always be reflected in code status orders, and assessments may differ between patients/surrogates and physicians about what goal of care is most important.
Details
- Title: Subtitle
- Code status orders and goals of care in the medical ICU
- Creators
- Thomas G Gehlbach - Division of Pulmonary and Critical Care Medicine, University of Iowa Carver College of Medicine, Iowa City, IALaura A Shinkunas - Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IAValerie L Forman-Hoffman - Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IAKarl W Thomas - Division of Pulmonary and Critical Care Medicine, University of Iowa Carver College of Medicine, Iowa City, IAGregory A Schmidt - Division of Pulmonary and Critical Care Medicine, University of Iowa Carver College of Medicine, Iowa City, IALauris C Kaldjian - Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA; Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: lauris-kaldjian@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.139(4), pp.802-809
- DOI
- 10.1378/chest.10-1798
- PMID
- 21292755
- PMCID
- PMC3198491
- NLM abbreviation
- Chest
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Grant note
- 5 T32 HL 07638-22 / NHLBI NIH HHS T32 HL007638 / NHLBI NIH HHS
- Language
- English
- Date published
- 04/2011
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Medical Ethics; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094727602771
Metrics
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