Increasing timely code status discussions in hospitalized children with medical complexity

Increasing timely code status discussions in hospitalized children with medical complexity
Journal of Hospital Medicine; by James Bowen, Laura Brower, Daniel Kadden, Jasmine Parker, Alexandra Delvalle, Andrew Krueger, Kristin Todd, Rachel Peterson; 4/25
Children with medical complexity (CMC) have an increased risk of hospitalization and clinical deterioration. Documentation of code statuses concordant with family goals is rare, increasing the risk of serious unintended consequences. We aimed to increase the percentage of patients with documentation of timely code status orders (CSOs) from 5% to 80% over 6 months. Multiple plan-do-study-act cycles were performed focusing on interventions aimed at key drivers, including increasing knowledge in performing code status discussions (CSDs) and improving understanding of institutional policies. The average percentage of patients who received a CSO placed in their chart within 72 h of admission to the CCT [complex care team] increased from 5% to 61% over 6 months.