A Pilot Study to Evaluate Compliance with Guidelines for Preprocedural Reconsideration of Code Status Limitations

Journal of Palliative Medicine
Richard D UrmanAngela M Bader

Abstract

Periprocedural providers are encountering more patients with code status limitations (CSLs) regarding their preferences for resuscitation and life-sustaining treatment who choose to undergo palliative procedures. Surgical and anesthesia guidelines for preprocedural reconsideration of CSLs have been available for several years, but it is not known whether they are being followed in practice. We assessed compliance with existing guidelines for patients undergoing venting gastrostomy tube (VGT) for malignant bowel obstruction (MBO), serving as an example of a palliative procedure received by patients near the end of life. Code status was determined at admission and throughout the hospitalization by chart review. Documentation of code status discussions (CSDs) was identified from provider notes and compared with existing guidelines. An institutional database retrospectively identified patients who underwent VGT placement for MBO at two academic hospitals (2014-2015). We identified 53 patients who underwent VGT placement for MBO. Interventional radiologists performed 88% of these procedures. Other periprocedural providers involved in these cases included surgeons, gastroenterologists, anesthesiologists, and sedation nurses. CSLs wer...Continue Reading

References

Jan 23, 1999·Anesthesiology·R D TruogJ P Burns
May 16, 2009·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·David B WaiselDaniel B Raemer
Feb 3, 2011·Journal of General Internal Medicine·Jacqueline K YuenMichael D Fetters
Dec 15, 2011·Annals of Surgery·Andrew J RedmannMargaret L Schwarze
Nov 26, 2015·A & a Case Reports·Rachel A HadlerLee A Fleisher
Jun 15, 2016·A & a Case Reports·Thomas R HickeyAngela M Bader
Mar 21, 2017·Anesthesia and Analgesia·Elisa C WalshRichard D Urman

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Citations

May 1, 2020·BMJ Quality & Safety·Alec PetersenMallika Mendu
May 22, 2018·Journal of Clinical Anesthesia·Ethan Y BrovmanRichard D Urman

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