A Missed Opportunity? - The impact of witnessing CPR in shared hospital rooms on patients’ goals of care.
CCCF ePoster library. Spring J. Oct 31, 2016; 155981; ORAL
Dr. Jenna Spring
Dr. Jenna Spring
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Abstract
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Topic: Retrospective or Prospective Cohort Study

A Missed Opportunity? - The impact of witnessing CPR in shared hospital rooms on patients’ goals of care.


Spring, Jenna1; Downar, James2
1Department of Medicine, University of Toronto, Toronto, Canada; 2 Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada



Abstract:

Introduction:
During an in-hospital cardiac arrest, other patients are frequently present for all or parts of the resuscitation.  However, little is known about how this experience impacts patients and whether or not it alters their goals of care.   
 
Objectives:
The primary objective of this study is to determine whether patients are more likely to change their wishes when it comes to end-of-life care after witnessing CPR as measured by a change in resuscitation order.
 
Methods:
In this retrospective chart review, we identified 200 patients admitted to a shared hospital room where CPR was performed between 2012-2014 at two major teaching hospitals.  The resuscitation order at the time of admission was recorded along with any changes to this order during the hospitalization.  We then looked at the timing of the code blue event in comparison to when the change in resuscitation order occurred to determine whether patients were more likely to change their goals of care after being admitted to a shared hospital room where a cardiac arrest took place.
 
Results:
Of the 200 patients included in the study, the median age was 70.5 years (IQR 57-80) and 54.5% were men.  The most common admitting services were GIM (42.5%), cardiology (12.5%) and general surgery (10%).  At the time of admission 54 patients (27%) were 'full code', 18 patients (9%) had a 'do not resuscitate' order and 128 patients (64%) had no resuscitation order documented.  
 
In terms of the code blue events, the median length was 24 minutes and 110 resuscitations (55%) were initially successful.  All of the code blue events involved CPR while 40 events (20%) involved defibrillation, and 149 events (74.5%) involved intubation.  The median time from admission to the code blue event was 5 days (IQR 2-13.25) with a median time from the code blue event to discharge that was also 5 days (IQR 2-13).
 
During their hospitalization, 27 patients (13.5%) changed their resuscitation order and 9 of these changes (33.3%) occurred on the same day or after the code blue event (Figure 1).  Prior to the code blue, changes in resuscitation order occurred at a rate of 0.75 changes per 100 patient days with 0.40 changes per 100 patient days after the code blue event (RR 1.09, 95% CI 0.45-2.66, p=0.84, Figure 2).  When the time window following the event was limited to one week for a change in resuscitation order, the HR was 1.50 but this did not reach statistical significance (p=0.42).   
 
Of the 18 patients with a 'do not resuscitate' order at the time of admission, none of them had a change in their final resuscitation order.  For the patients with no documented resuscitation order, 12 (9.4%) changed to 'do not resuscitate', 3 (2.3%) changed to full code, and 113 (88.3%) continued to have no documented resuscitation order for the duration of their admission.
 
Conclusion:
Patients in a shared hospital room where CPR was performed are not more likely to change their goals of care than other patients.  There was a trend towards a change in resuscitation order in the immediate aftermath of the event but this did not reach statistical significance.  However, a resuscitation order was not clearly documented at any time during the admission for the majority of patients in our study.  A code blue event in a shared hospital room may represent a valuable opportunity to address or revisit goals of care that is not currently being utilized based on our results.


References:

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