Is the Emergency Department an Inappropriate Venue for Code Status Discussions?
Daniel G Miller, J Priyanka Vakkalanka, Morgan B Swanson and 2 others
PMID 32613837WHAT IT FOUND
Requiring code status orders before inpatient admission from the emergency department increased do-not-resuscitate orders there.
It did not reduce later do-not-resuscitate orders or change death, intensive care admission, or stay length.
Key findings
01In 15,927 adult ED admissions (7,858 before, 8,069 after), DNR orders placed in the ED rose from 0.4% to 5.3%, and missing ED code status fell from 98.6% to 2.4%.
02Overall any DNR rose from 10.0% to 12.6%, but inpatient DNR orders did not change.
03Hospital mortality, ICU admission, and length of stay did not change; mortality was 4.1% before and 4.0% after, and average stay differed by 0.09 days.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study compared patients before and after a policy, so it can suggest but cannot prove the policy caused the changes. It was done at one academic hospital, so results may not apply elsewhere. The data did not show which patients had DNR preferences that were missed before the policy. The researchers did not observe the conversations, so they could not judge whether code status discussions were good or merely a checkbox.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that mandatory code status orders improve the quality of end-of-life discussions or patient outcomes. The study did not observe the conversations, and mortality, ICU admission, and length of stay did not change.