title: Frequency and clinical relevance of inconsistent code status documentation.
abstract: BACKGROUND
  Accurate and complete documentation of hospitalized patients' code status is important to ensure that healthcare providers take appropriate action in the event of a cardiac arrest.
  
  
  OBJECTIVE
  Determine the frequency and clinical relevance of incomplete and inconsistent code status documentation.
  
  
  METHODS
  Point-prevalence study.
  
  
  METHODS
  Academic medical centers.
  
  
  METHODS
  Patients admitted to general internal medicine wards.
  
  
  METHODS
  Frequency and clinical relevance of inconsistent code status documentation across 5 documentation sources.
  
  
  RESULTS
  Thirty-eight (20%; 95% confidence interval [CI], 14%-26%) of 187 patients had complete and consistent code status documentation. Another 27 (14%; 95% CI, 9%-19%) patients had no code status documentation. The remaining 122 (65%; 95% CI, 58%-72%) patients had at least 1 code status documentation inconsistency. Of these, 38 (20%; 95% CI, 14%-26%) patients had a clinically relevant code status documentation inconsistency. Multivariate logistic regression analysis demonstrated that increased age (odds ratio [OR] = 1.07 [95% CI, 1.05-1.10] for every 1-year increase in age, P < 0.001) and patients receiving comfort measures (OR = 9.39 [95% CI, 1.35-65.19], P = 0.02) were independently associated with a clinically relevant code status documentation inconsistency.
  
  
  CONCLUSIONS
  Incomplete and inconsistent documentation of code status occurred frequently in hospitalized patients, especially elderly patients and patients receiving comfort measures. Having multiple, poorly integrated code status documentation sources leads to a significant number of concerning inconsistencies that create opportunities for healthcare providers to inappropriately deliver or withhold resuscitative measures that conflict with patients' expressed wishes. Institutions need to be aware of this potential documentation hazard and take steps to minimize code status documentation inconsistencies.
authors: Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Adina S
authors: AS
authors: Weinerman
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.|Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.
authors: Irfan A
authors: IA
authors: Dhalla
authors: Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.
authors: Alex
authors: A
authors: Kiss
authors: Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Edward E
authors: EE
authors: Etchells
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.
authors: Robert C
authors: RC
authors: Wu
authors: Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Centre for Quality Improvement and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Brian M
authors: BM
authors: Wong
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards*; D008297:Male; D008875:Middle Aged