Code status orders in hospitalized patients with COVID-19.
COVID-19
Code Status
Journal
Resuscitation plus
ISSN: 2666-5204
Titre abrégé: Resusc Plus
Pays: Netherlands
ID NLM: 101774410
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
21
03
2023
revised:
18
07
2023
accepted:
01
08
2023
medline:
4
9
2023
pubmed:
4
9
2023
entrez:
4
9
2023
Statut:
epublish
Résumé
The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19. A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020). Among 1375 hospitalized patients with COVID-19, 19% ( There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.
Sections du résumé
Background
UNASSIGNED
The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19.
Methods
UNASSIGNED
A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020).
Results
UNASSIGNED
Among 1375 hospitalized patients with COVID-19, 19% (
Conclusions
UNASSIGNED
There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.
Identifiants
pubmed: 37662642
doi: 10.1016/j.resplu.2023.100452
pii: S2666-5204(23)00095-4
pmc: PMC10470381
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100452Informations de copyright
© 2023 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Gerontology. 2011;57(5):414-21
pubmed: 21099190
JAMA. 2020 Apr 21;323(15):1439-1440
pubmed: 32163102
Resuscitation. 2021 Apr;161:408-432
pubmed: 33773832
J Vasc Surg. 2015 Jun;61(6):1538-42
pubmed: 25704406
J Gen Intern Med. 2011 Apr;26(4):359-66
pubmed: 21104036
BMC Palliat Care. 2021 Jan 11;20(1):10
pubmed: 33430850
J Gen Intern Med. 2021 Oct;36(10):3210-3211
pubmed: 33886029
Camb Q Healthc Ethics. 2021 Apr;30(2):215-221
pubmed: 32576307
Chest. 2007 Sep;132(3):751-4; discussion 754-5
pubmed: 17873189
BMJ. 2020 Sep 30;371:m3513
pubmed: 32998872
Crit Care Med. 2021 Feb 1;49(2):347-351
pubmed: 33196527
SSM Popul Health. 2018 Nov 30;7:100331
pubmed: 30623009
Am J Emerg Med. 2021 Aug;46:714-716
pubmed: 33082062
J Pain Symptom Manage. 2019 Aug;58(2):216-223
pubmed: 31100320
Geriatrics (Basel). 2021 Apr 01;6(2):
pubmed: 33916039
Ann Intern Med. 2020 Aug 4;173(3):230-232
pubmed: 32330235
Chest. 2013 Mar;143(3):656-663
pubmed: 23187703
Crit Care Med. 2013 Jul;41(7):1686-91
pubmed: 23660727
J Hosp Med. 2008 Nov-Dec;3(6):437-45
pubmed: 19084893
Nurs Ethics. 2021 Feb;28(1):66-81
pubmed: 33430698
Int J Nurs Stud. 2021 Sep;121:104000
pubmed: 34242976
Stroke. 2004 May;35(5):1130-4
pubmed: 15044768
Ann Intern Med. 2020 Dec 15;173(12):1028-1029
pubmed: 33316189
Curr Opin Crit Care. 2021 Jun 1;27(3):239-245
pubmed: 33783396
Ann Am Thorac Soc. 2017 Apr;14(4):536-542
pubmed: 28099054
J Gen Intern Med. 2012 Oct;27(10):1361-7
pubmed: 22618581
J Am Geriatr Soc. 2002 Dec;50(12):2057-61
pubmed: 12473020
J Pain Symptom Manage. 2021 Dec;62(6):1111-1116
pubmed: 34147579
JAMA Netw Open. 2019 Jul 3;2(7):e197229
pubmed: 31322688
Front Public Health. 2021 May 12;9:560405
pubmed: 34055703
J R Soc Med. 2020 Jun;113(6):211-216
pubmed: 32521198
N Engl J Med. 2020 Jul 9;383(2):e6
pubmed: 32374958
Palliat Support Care. 2011 Dec;9(4):401-6
pubmed: 22104416
Virtual Mentor. 2010 Jun 01;12(6):466-70
pubmed: 23158448
J Gen Intern Med. 2009 Jun;24(6):695-701
pubmed: 19387750
JAMA. 2020 May 12;323(18):1771-1772
pubmed: 32219360
HSS J. 2020 Nov;16(Suppl 1):195-199
pubmed: 33020699
Lancet Respir Med. 2023 May;11(5):453-464
pubmed: 36828006
Clin Dermatol. 2021 May-Jun;39(3):510-516
pubmed: 34518012