Structured Workflow to Manage Periprocedural Code Status for Patients With Do-Not-Resuscitate Orders.

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.