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Related Experiment Video

Updated: Sep 11, 2025

Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
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Structured Workflow to Manage Periprocedural Code Status for Patients With Do-Not-Resuscitate Orders.

Carrie Fisher1, Danielle Noreika1, Kyeong Ri Yu2

  • 1Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.

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Summary

Implementing a new workflow improved code status management for patients with Do Not Resuscitate (DNR) orders undergoing cardiac procedures. This interdisciplinary approach enhanced patient-centered care and procedural compliance.

Keywords:
cardiologycode statusdo not resuscitate

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Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Bioethics

Background:

  • Patient-centered care necessitates respecting resuscitation wishes, yet compliance with Do Not Resuscitate (DNR) orders during invasive procedures remains low.
  • Existing best practice guidelines often fall short in managing code status for patients with DNR orders undergoing cardiac catheterization (CC) or electrophysiology (EP) procedures.

Discussion:

  • An interdisciplinary team developed and implemented a novel workflow for managing DNR status in inpatients undergoing CC/EP procedures.
  • The workflow involved collaboration between nursing, cardiology, surgery, palliative care, internal medicine, and IT, facilitating temporary DNR rescission for procedures.
  • Stakeholders found the workflow efficient and clear, highlighting the importance of interdisciplinary teamwork and IT support.

Key Insights:

  • The workflow was applied to 32 inpatients (average age 76.6 years), with preprocedural code status discussions documented in 78% of cases.
  • A significant portion (37.5%) of procedures aimed to extend patient life, with four deaths occurring during the same hospitalization.
  • The intervention demonstrated successful temporary DNR management, improving adherence to patient wishes during critical cardiac interventions.

Outlook:

  • Further refinement of such workflows can enhance compliance and ensure consistent patient-centered care during invasive procedures.
  • Continued interdisciplinary collaboration and technological integration are crucial for optimizing code status management in complex patient populations.
  • This model offers a scalable solution for improving resuscitation care decisions in high-risk cardiac interventions.