Assessing the Quality of Internal Medicine Resident-Led Code Status Discussions: A Multicenter Cross-Sectional Study

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

RATIONALE: Code status (CS) discussions are central in the care of critically ill or acutely deteriorating patients. This study aims to evaluate the quality of patient-centered CS discussions led by internal medicine (IM) residents. METHODS: After reviewing previously published surveys, we developed and distributed an anonymous online survey to residents at four IM residency programs in the United States. Our study examined the frequency, quality, knowledge of outcomes, and confidence levels related to CS discussions. Response variables from a 5-point scale were grouped as “most of the time/often” or “nearly always” against other answers (sometimes, rarely, never). Respondents were considered to possess basic knowledge of cardiopulmonary resuscitation outcomes if they correctly answered one of two questions regarding likelihood of survival to discharge and meaningful neurological recovery after in-hospital cardiac arrest. Discussions were deemed “ideal” if they met all criteria of informed consent; indications, details, risks, benefits, and alternatives. Patient-centered discussion was defined as provision of information on likelihood of discharge and exploration of patients' perspectives on a meaningful quality of life. Results were stratified by postgraduate year (PGY) and exposure to palliative medicine using chi-square tests (or Fisher exact test for observations <=5). RESULTS: We received 112 responses (35.8% response rate), with 44% of respondents being PGY1, and 56% being PGY2/3. Experiences with palliative medicine varied, with 21% having completed a palliative medicine rotation. PGY2/3 residents conversed about CS with patients more frequently than PGY1s (87% vs 67%, p<0.05) (Table 1). Overall, only 12% of residents discussed patient specific survival to discharge likelihood following cardiac arrest. Patient perspectives on a “meaningful” quality of life were explored by 39% of residents. Of the two knowledge questions, merely 28% of residents correctly identified the likelihood of survival to discharge after in-hospital cardiac arrest. Although PGY2/3 residents were more confident in discussions than PGY1s (62% vs 41%, p<0.05), there was no statistically significant difference in knowledge, quality, or patient-centered components of their discussions. Only 4.5% of residents achieved “ideal” discussions. Those with greater palliative medicine exposure were slightly more confident (62% vs 45%, p=0.08), without other discernible variation. CONCLUSION: While resident physicians frequently engage in CS conversations, many lack knowledge on outcomes and seldom fulfill all criteria for informed consent or patient-centered conversation. Senior residents conduct these conversations more consistently without significant improvement in quality. Further CS discussion training for IM residents should focus on improving both outcome related knowledge and discussion quality

Volume

209

Issue

Suppl

First Page

A1494

Comments

International Conference of the American Thoracic Society, May 17-22, 2024, San Diego, CA

DOI

10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A1494

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