Intraoperative code status: Moving from misinformation to respect for patient autonomy

Intraoperative code status remains a complicated topic for patients and providers. Previous studies have demonstrated a lack of understanding of intraoperative do not resuscitate status. Few studies have used simulation-based education for surgical residents to navigate conversations with patients who request intraoperative do not resuscitate status. This project aims to implement a simulation-based curriculum for residents to navigate intraoperative do not resuscitate status while maintaining and fostering respect for patient autonomy.

Anesthesiology and surgery residents were surveyed regarding clinical practice and policy surrounding intraoperative code status, which demonstrated a knowledge gap. To address this, a simulation-based curriculum was developed wherein surgery residents encounter a standardized patient who requests intraoperative do not resuscitate status. A posttraining survey assessed the effectiveness of this simulation.

Targeted needs assessment demonstrated 56.5% of surgery residents incorrectly believed do not resuscitate status must be rescinded for an elective operation and 52.1% believed this for an emergent operation. Results from posttraining survey responses demonstrated a statistically significant (P < .001, Figure 1) change in confidence discussing intraoperative do not resuscitate status and a statistically significant reduction in the misconception that a do not resuscitate order must be rescinded before surgery (P < .01, Figure 2).

A simulation-based curriculum was created to meet the need for clear discussion of intraoperative do not resuscitate policy while emphasizing respect for patient autonomy. Posttraining survey demonstrated a significant increase in confidence and understanding when discussing intraoperative do not resuscitate status and ethics policy. Our future aims will assess curriculum impact on practice patterns and hospital outcomes via a 6-month follow-up survey.