Code status documentation at admission in COVID-19 patients: a descriptive cohort study

Area of Science:

• Medical Ethics
• Healthcare Management
• Infectious Diseases

Background:

• The COVID-19 pandemic strained healthcare systems, increasing awareness of advance care planning and code status documentation.
• It remains unclear if this heightened awareness impacted the prevalence and content of code status documentation for COVID-19 patients.

Purpose of the Study:

• To compare code status documentation practices between patients with COVID-19 and infectious patients treated before the pandemic.
• To analyze differences in the frequency, discussion, and content of code status documentation.

Main Methods:

• A retrospective cohort study was conducted at a tertiary care academic hospital.
• Included were 129 COVID-19 patients (March-June 2020) and 1586 pre-COVID-19 infectious patients (September 2016-September 2018).
• Code status documentation frequency, discussion with patients/families, and specific limitations were described.

Main Results:

• Code status documentation (69.8% vs 72.7%) and discussion frequencies (75.6% vs 73.3%) were similar between COVID-19 and pre-COVID-19 cohorts.
• Treatment limitations were more frequent in the COVID-19 cohort (40% vs 25%).
• Specific limitations like 'no intensive care admission' (81% vs 51%) and 'no intubation' (69% vs 40%) were significantly higher in COVID-19 patients.

Conclusions:

• The frequency of code status documentation and discussions did not change significantly due to the COVID-19 pandemic.
• However, COVID-19 patients exhibited a higher prevalence of treatment limitations, particularly regarding intensive care and intubation.
• This suggests a shift towards more specific limitations in end-of-life care planning during the pandemic.