Improving Code Status Documentation Rates Using Communication Skills Training in Vascular Surgery: A Quality...

Area of Science:

• Medical Education
• Quality Improvement
• Surgical Specialties

Background:

• Code status discussions are critical for patient care but poorly understood and inconsistently performed, especially in surgical fields like Vascular Surgery.
• Lack of documented code status hinders clinical decision-making during emergencies, potentially leading to unwanted interventions and poor outcomes.
• Surgical trainees receive fewer communication skills interventions compared to non-surgical peers, exacerbating documentation deficits.

Purpose of the Study:

• To assess the impact of a communication skills training (CST) and documentation intervention on code status documentation rates in Vascular Surgery.
• To improve provider comfort and preparedness in discussing code status with patients and their families.
• To enhance the quality of care by ensuring patient preferences are known and respected in critical situations.

Main Methods:

• A before-after Plan-Do-Study-Act quality improvement project was implemented over 12 months (May 2018-May 2019).
• A needs assessment established baseline code status documentation rates.
• Vascular Surgery trainees and Advance Practice Providers (APPs) received CST and ongoing reminders via departmental emails.

Main Results:

• Code status documentation rates increased from a baseline of 7.8% to 44.9% by the end of the 12-month intervention.
• These improved documentation rates were sustained at 45.2% six months post-intervention.
• Participants reported increased comfort initiating code status discussions and making recommendations for cardiopulmonary resuscitation (CPR) status.

Conclusions:

• CST and regular reminders effectively enhanced the comfort of vascular surgery residents and APPs in conducting code status discussions.
• The intervention led to a significant and sustained increase in the documentation of code status discussions.
• This quality improvement initiative positively impacted patient care by improving adherence to documented patient preferences.