Journal article
Is the Emergency Department an Inappropriate Venue for Code Status Discussions?
American journal of hospice & palliative medicine, Vol.38(3), pp.253-259
03/01/2021
DOI: 10.1177/1049909120938332
PMCID: PMC7775892
PMID: 32613837
Abstract
Background: Historically, it has been assumed that the Emergency Department (ED) is a place for maximally aggressive care and that Emergency Medicine Providers (EMPs) are biased towards life-prolonging care. However, emphasis on early recognition of code status preferences is increasingly making the ED a venue for code status discussions (CSDs). In 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. We hypothesized that if EMPs enter CSDs with a bias toward life-prolonging care, or if the venue of the ED biases CSDs towards life-prolonging care, then we would observe a decrease in the percentage of patients selecting DNR status following our institution's aforementioned CSO mandate. Methods: We present a retrospective analysis of rates of DNR orders placed for patients admitted through our ED comparing six-month periods before and after the implementation of the above policy. Results: Using quality improvement data, we identified patients admitted through the ED during pre (n=7,858) and post (n=8,069) study periods. We observed the following: after implementation DNR preference identified prior to hospital admission from the ED increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9), defining CS in the ED setting at the time of admission increased from 2.4% to 98.6% (p <0.001), and DNR orders placed during inpatient admission was unchanged (RR=0.97 (95% CI = 0.88-1.07)). Discussion: Our results suggest that the ED can be an appropriate venue for CSDs.
Details
- Title: Subtitle
- Is the Emergency Department an Inappropriate Venue for Code Status Discussions?
- Creators
- Daniel G. Miller - Roy J. and Lucille A. Carver College of MedicineJ. Priyanka Vakkalanka - University of IowaMorgan B. Swanson - University of IowaAndrew S. Nugent - Roy J. and Lucille A. Carver College of MedicineYuya Hagiwara - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- American journal of hospice & palliative medicine, Vol.38(3), pp.253-259
- DOI
- 10.1177/1049909120938332
- PMID
- 32613837
- PMCID
- PMC7775892
- NLM abbreviation
- Am J Hosp Palliat Care
- ISSN
- 1049-9091
- eISSN
- 1938-2715
- Publisher
- Sage
- Number of pages
- 7
- Grant note
- University of Iowa Hospitals and Clinics Department of Emergency Medicine
- Language
- English
- Date published
- 03/01/2021
- Academic Unit
- Epidemiology; Emergency Medicine; Injury Prevention Research Center; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984297149902771
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