Some treatment-withholding implications of no-code orders in an academic hospital.
To identify treatment-withholding intentions for 56 VA medicine inpatients who received a no-code order, 31 resident physicians who wrote the orders completed a checklist on which they indicated the interventions they intended to withhold from each patient. Review of patients' charts indicated that 24 (43%) contained no documentation of treatment limitation plans beyond the no-code order. To identify the general interpretations of no-code orders, "cross-covering" physicians indicated on a questionnaire the likelihood that they would withhold specific interventions from patients they were covering who had received a no-code order. Both the intention and interpretation of no-code orders were characterized by variability, and interpretation of the orders was characterized by uncertainty as well. Because of these discrepancies, we suggest a no-code order which provides greater specificity for individual patients.
D004282:Documentation / Q000592:standards; D006745:Hospital Bed Capacity, 300 to 499; D006787:Hospitals, Veterans; D006801:Humans; D007396:Internship and Residency; D008499:Medical Records / Q000592:standards*; D009922:Oregon; D012151:Resuscitation / Q000592:standards*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D028761:Withholding Treatment