Variation in the design of Do Not Resuscitate orders and other code status options: a multi-institutional qualitative study.
Background US hospitals typically provide a set of code status options that includes Full Code and Do Not Resuscitate (DNR) but often includes additional options. Although US hospitals differ in the design of code status options, this variation and its impacts have not been empirically studied. Desi...
| Publicado en: | BMJ Quality & Safety Vol. 30; no. 8; pp. 668 - 678 |
|---|---|
| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BMJ Publishing Group
Aug2021
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151615855&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151615855 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20445415 BFNQ jtl: BMJ Quality & Safety issn: 20445415 maglogo: N pubinfo: dt: Aug2021 vid: 30 iid: 8 pid: 8280 pub: BMJ Publishing Group artinfo: ui: 151615855 151615855 151615855 10.1136/bmjqs-2020-011222 151615855 ppf: 668 ppct: 10 formats: tig: atl: Variation in the design of Do Not Resuscitate orders and other code status options: a multi-institutional qualitative study. aug: au: Batten, Jason N. Blythe, Jacob A. Wieten, Sarah Cotler, Miriam Piven Kayser, Joshua B. Porter-Williamson, Karin Harman, Stephanie Dzeng, Elizabeth Magnus, David affil: Department of Medicine, Stanford University, Stanford, California, USA sug: subj: Resuscitation Orders United States Decision Making Human Male Female United States Qualitative Studies Multicenter Studies Hospitals Geographic Locations Communication Exploratory Research Physicians Interviews Content Analysis Male Female ab: Background US hospitals typically provide a set of code status options that includes Full Code and Do Not Resuscitate (DNR) but often includes additional options. Although US hospitals differ in the design of code status options, this variation and its impacts have not been empirically studied. Design and methods Multi-institutional qualitative study at 7 US hospitals selected for variability in geographical location, type of institution and design of code status options. We triangulated across three data sources (policy documents, code status ordering menus and in-depth physician interviews) to characterise the code status options available at each hospital. Using inductive qualitative methods, we investigated design differences in hospital code status options and the perceived impacts of these differences. Results The code status options at each hospital varied widely with regard to the number of code status options, the names and definitions of code status options, and the formatting and capabilities of code status ordering menus. DNR orders were named and defined differently at each hospital studied. We identified five key design characteristics that impact the function of a code status order. Each hospital's code status options were unique with respect to these characteristics, indicating that code status plays differing roles in each hospital. Physician participants perceived that the design of code status options shapes communication and decisionmaking practices about resuscitation and life-sustaining treatments, especially at the end of life. We identified four potential mechanisms through which this may occur: framing conversations, prompting decisions, shaping inferences and creating categories. Conclusions There are substantive differences in the design of hospital code status options that may contribute to known variability in end-of-life care and treatment intensity among US hospitals. Our framework can be used to design hospital code status options or evaluate their function. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|