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Perioperative Code Status Discussions: How Are We Doing?

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This summary is machine-generated.

Many patients with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders undergo surgery. Code status discussions (CSDs) are inconsistently documented, highlighting a need for improved perioperative care processes.

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Area of Science:

  • Medical Ethics
  • Perioperative Medicine
  • Healthcare Quality Improvement

Background:

  • Approximately 15% of surgical patients have existing do-not-resuscitate (DNR) or do-not-intubate (DNI) orders.
  • Professional guidelines emphasize patient discussions regarding perioperative resuscitation, but adherence is uncertain.

Purpose of the Study:

  • To evaluate the documentation rates of code status discussions (CSDs) in surgical patients with DNR/DNI status.
  • To identify challenges in accurately reflecting patient code status in medical orders.
  • To propose solutions for improving CSD documentation and adherence to guidelines.

Main Methods:

  • Retrospective review of 158 patient encounters with established DNR/DNI code status prior to surgery.
  • Analysis of documentation rates for code status discussions.
  • Assessment of the consistency between discussions and electronic health record (EHR) orders.

Main Results:

  • Code status discussions were documented in only 70% of reviewed patient encounters.
  • Code status orders were inconsistently entered, often not reflecting the documented discussions.
  • Significant gaps exist in the consistent application of guidelines for DNR/DNI patients undergoing surgery.

Conclusions:

  • There is a critical need to enhance the documentation and implementation of code status discussions for DNR/DNI patients in the perioperative setting.
  • Improving perioperative workflows, EHR order entry, and patient consent forms can enhance CSD documentation.
  • Systematic improvements are necessary to ensure patient wishes are honored during surgical procedures.