An Agenda for Improving Perioperative Code Status Discussion.
Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians. In this article, we describe the difficulty of achieving a patient-centered, shared perioperative CSD in the case of a medical professional with a do-not-resuscitate order. We provide a brief background in cardiopulmonary resuscitation, do-not-resuscitate, and CSD before proposing an agenda for improving perioperative CSD.
From the *Yale University School of Medicine, Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, Connecticut; †Department of Surgery, Division of Trauma, Burns, and Surgical Critical Care, and the Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; ‡Ariadne Labs, Boston, Massachusetts; §Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; and ‖Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Thomas R
TR
Hickey
Zara
Z
Cooper
Richard D
RD
Urman
David L
DL
Hepner
Angela M
AM
Bader
D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery*; D016414:Resuscitation Orders