Code status discussions in psychiatric and medical inpatients

Area of Science:

• Medical Ethics
• Palliative Care
• Psychiatric Hospitalization

Background:

• Patient Self-Determination Act mandates collaboration on goals of care and emergency measures.
• Code status discussions are often overlooked in psychiatric hospitalizations due to perceived medical stability.
• Understanding disparities in code status documentation is crucial for improving care processes.

Purpose of the Study:

• To compare code status documentation and discussion between psychiatric and medical inpatients.
• To identify potential gaps in advance care planning for psychiatric patients.
• To inform interventions for enhancing care processes.

Main Methods:

• Retrospective chart review of psychiatric and medical inpatients over a 12-month period.
• Data collection included demographics, cancer diagnosis, code status orders, advance directives, length of stay, and mortality.
• Comparison of code status documentation and discussion between the two patient groups.

Main Results:

• Medical inpatients showed higher rates of documented code status orders on admission (96% vs 65%) and "full-code, discussed" orders (67% vs 33%).
• Psychiatric inpatients had more "do not resuscitate/do not intubate" orders (20% vs 13%) and more frequent changes in code status orders (18% vs 7%).
• Psychiatric inpatients presented a higher percentage of advance directives (46% vs 25%).

Conclusions:

• Code status discussions are essential for all hospitalized patients upon admission, irrespective of the reason for admission.
• There is a clear need for targeted strategies to improve code status discussion and documentation for psychiatric inpatients.
• Enhancing advance care planning processes in psychiatric settings is critical for patient-centered care.