A Daily Checklist Method Increases Documentation of Code Status in Trauma Patients

Area of Science:

• Medical Quality Improvement
• Trauma Critical Care
• Patient Decision-Making

Background:

• Insufficient code status documentation (CSD) is a persistent challenge, particularly for trauma patients with unpredictable prognoses.
• Previous interventions using reminder systems had limited success in increasing CSD.
• Ensuring CSD allows patients to participate in critical care decisions.

Purpose of the Study:

• To evaluate the effectiveness of a twice-daily checklist in improving CSD for trauma patients.
• To determine if a checklist intervention could increase the rate and timeliness of code status documentation.

Main Methods:

• A quality improvement study was conducted at a level I trauma center.
• A pre-intervention (PRE) and post-intervention (POST) daily census compared CSD rates.
• Key outcomes included percentage of patients with CSD, time-to-code status (TTCS), and patients discharged without code status (DNCS).

Main Results:

• Daily CSD increased from 50.0% (PRE) to 64.4% (POST).
• Time-to-code status documentation was reduced by half (25.30h PRE vs. 12.71h POST).
• Overall CSD during hospitalization rose by 20%, and patients discharged without CSD decreased by 20%.

Conclusions:

• A daily checklist integrated into trauma patient care effectively improves code status documentation.
• Enhanced CSD facilitates patient-centered, goal-concordant care for trauma patients.
• This intervention supports better end-of-life care planning in critical care settings.