Impact of the COVID-19 Public Health Crisis and a Structured COVID Unit on Physician Behaviors in Code Status Ordering.

The study measured only whether a code status order was placed. It could not assess the quality of advance care planning, goals-of-care conversations, or whether the order matched patient wishes. The data could not show whether a code status order was entered without a conversation with the patient. The study did not examine outcomes after code status ordering, such as ICU transfers, code blues, or rapid responses. The dataset could not identify specific providers, so the study could not separate the pandemic effect from the behaviors of volunteer COVID unit providers. The COVID unit bundled several practices, including standardized discussions, templated documentation, order placement and handoff communication, so the contribution of any single component cannot be separated. The results came before vaccines were widely distributed and before more standardized treatment plans, and early testing limitations likely undercounted COVID-positive patients. The sample came from one inpatient system and was predominantly Black, so the ordering patterns may not match other hospitals.

The supplied text says the work was presented as an abstract at the Society of Hospital Medicine Annual Meeting April 7–10, 2022, and the American Sociological Association Annual Meeting August 5–9, 2022. It does not list a funding source or other conflict disclosures.

Do not read the higher code status order rates as proof that patients had goals-of-care conversations or that the COVID unit's templated phrase alone caused the change. The study only counted whether an order was placed, could not confirm whether a conversation occurred, and the COVID unit bundled discussions, documentation, order placement and handoff communication.