A Pilot Study to Evaluate Compliance with Guidelines for Preprocedural Reconsideration of Code Status Limitations

Area of Science:

• Medical ethics
• Palliative care
• Surgical oncology

Background:

• Increasing number of patients with code status limitations (CSLs) are undergoing palliative procedures.
• Existing surgical and anesthesia guidelines for preprocedural reconsideration of CSLs are not widely followed.
• Compliance with guidelines for patients with CSLs undergoing palliative procedures is unknown.

Purpose of the Study:

• To assess compliance with existing guidelines for patients undergoing venting gastrostomy tube (VGT) placement for malignant bowel obstruction (MBO).
• To evaluate the documentation of code status discussions (CSDs) in patients with CSLs undergoing palliative procedures.
• To identify areas for improvement in ensuring goal-concordant care for patients with CSLs.

Main Methods:

• Retrospective review of an institutional database of patients who underwent VGT placement for MBO.
• Chart review to determine code status at admission and throughout hospitalization.
• Identification and comparison of documented CSDs with existing guidelines.

Main Results:

• Only 43% of patients had documented CSLs before the procedure.
• A documented CSD with a periprocedural provider was identified in only 22% of CSL cases.
• Only 13% of VGT placements in patients with CSLs were compliant with preprocedural reconsideration guidelines.

Conclusions:

• Increased compliance with established guidelines is necessary for goal-concordant care of patients with CSLs undergoing procedures.
• Training for all periprocedural providers should incorporate guidelines for managing patients with CSLs.
• Efforts are needed to ensure adherence to guidelines for CSLs in palliative procedures.