Code status documentation at admission in COVID-19 patients: a descriptive cohort study

BMJ Open, vol. 11, pp. e050268

Abstract

OBJECTIVES: The COVID-19 pandemic pressurised healthcare with increased shortage of care. This resulted in an increase of awareness for code status documentation (ie, whether limitations to specific life-sustaining treatments are in place), both in the medical field and in public media. However, it is unknown whether the increased awareness changed the prevalence and content of code status documentation for COVID-19 patients. We aim to describe differences in code status documentation between infectious patients before the pandemic and COVID-19 patients. SETTING: University Medical Centre of Utrecht, a tertiary care teaching academic hospital in the Netherlands. PARTICIPANTS: A total of 1715 patients were included, 129 in the COVID-19 cohort (a cohort of COVID-19 patients, admitted from March 2020 to June 2020) and 1586 in the pre-COVID-19 cohort (a cohort of patients with (suspected) infections admitted between September 2016 to September 2018). PRIMARY AND SECONDARY OUTCOME MEASURES: We described frequency of code status documentation, frequency of discussion of this code status with patient and/or family, and content of code status. RESULTS: Frequencies of code status documentation (69.8% vs 72.7%, respectively) and discussion (75.6% vs 73.3%, respectively) were similar in both cohorts. More patients in the COVID-19 cohort than in the before COVID-19 cohort had any treatment limitation as opposed to full code (40% vs 25%). Within the treatment limitations, 'no intensive care admission' (81% vs 51%) and 'no intubation' (69% vs 40%) were more frequently documented in the COVID-19 cohort. A smaller difference was seen in 'other limitation' (17% vs 9%), while 'no resuscitation' (96% vs 92%) was comparable between both periods. CONCLUSION: We observed no difference in the frequency of code status documentation or discussion in COVID-19 patients opposed to a pre-COVID-19 cohort. However, treatment limitations were more prevalent in patients with COVID-19, especially 'no intubation' and 'no intensive care admission'.

Authors 8

1. Saskia Briedé corresponding

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands

2. Harriët M. R. van Goor

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands

3. Titus A. P. de Hond

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands

4. Sonja E. van Roeden

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands

5. Judith M. Staats

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands

6. Jan Jelrik Oosterheert

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands

7. Frederiek van den Bos Aachen Department of Internal Medicine Section of Gerontology and Geriatrics

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands

8. Karin A. H. Kaasjager

   University Medical Center Utrecht

   Affiliation as printed

   Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands