Background: Cardiac arrest on the wards may be preceded by unmet palliative care needs, including advance care planning and specialty palliative consultation that can seek to align patients’ prognoses and goals for care. Identification of hospitalized patients with limited life expectancy allows for the delivery of appropriate palliative interventions. However, the prognosis on admission of [...]

Background: Many patients and their surrogates have a poor understanding of the process of cardiopulmonary resuscitation (CPR), its limitations, and its complications. Lack of knowledge about CPR may lead patients to choose a code status that does not align with their goals and values. Studies have shown that showing patients an educational video about code [...]

Background: Although code status discussion does not routinely happen at hospitals in Japan, many people reportedly start to think of their end of life issue and would like to express it, according to questionnaire survey conducted by the Ministry of Health, Labour and Welfare. There has been no report which focuses on prevalence of do-not-resuscitate [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, and are associated with withholding treatments outside of the cardiac arrest setting. [...]

Background: Cardiopulmonary resuscitation (CPR) is part of the standard of care for the event of cardiac arrest during hospital admissions. The “do not resuscitate” (DNR) order documents that patients do not wish to pursue CPR in the event of cardiopulmonary arrest (CPA). The Ministry of Health has announced that 69.7% of middle-aged home residents in [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. Furthermore, in-hospital cardiopulmonary resuscitation (CPR) is associated with worse outcomes than intubation. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, [...]

Background: Documentation of code status is critical to goal-concordant care. Historically, documentation rates have been low due to time, the sensitive nature of discussions, and lack of experience. The COVID-19 pandemic, due to the risk of rapid decompensation and in-hospital mortality, created an urgent need for documentation of code status preferences among patients admitted to [...]

Background: Do-not-resuscitate (DNR) orders are intended to allow patients to forgo cardiopulmonary resuscitate (CPR) in the event of cardiac arrest. They are applied to cases of cardiac arrest, and they cannot be applied to any situation other than cardiac arrest. However, prior studies have shown that the presence of DNR orders led to changes in treatment [...]

Background: Hospitalization of the patient with advanced cancer can be a pivotal moment and opportunity to explore patient goals of care in order to deliver high value, patient-centered care that emphasizes quality of life. Part of this discussion should define patient preferences regarding code status as it is known that prognosis is extremely poor and [...]

Background: Problem Definition: Inadequate Advance Care Planning conversations and documentation remain a persistent gap in healthcare delivery. Admitting patients to the inpatient service without explicitly exploring the ‘goals of care’ and ‘code status’ results in stressful moments for the patients, their families, and providers if the condition deteriorates and may result in providing care that [...]