SHM Converge Scientific Abstract ePoster Gallery-Code Status Preference and Quality of Goals of Care Documentation in Hospitalized Adults Prior to Decompensation and Transfer to Icu

Code Status Preference and Quality of Goals of Care Documentation in Hospitalized Adults Prior to Decompensation and Transfer to Icu

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This retrospective study examined the quality of goals of care (GOC) documentation in hospitalized adult general medicine patients who later deteriorated and were transferred to the ICU at a single academic medical center (July 2022–June 2024). Investigators manually reviewed charts for five key elements of high-quality GOC discussions: prognosis or understanding of illness, patient values/goals, identification of a durable power of attorney (DPOA) or personal representative, limitations on life-sustaining interventions, and documentation of who participated in the discussion.<br /><br />Among 373 patients, documentation quality was generally poor. A substantial proportion had no documented GOC components, and only 80 patients had at least two key components documented. The most common documented elements were patient values/goals and prognosis; DPOA and discussion participants were less frequently recorded.<br /><br />Patients with higher-quality documentation were older and more likely to have dementia, metastatic cancer, or other solid tumors. They also had longer hospital length of stay before ICU transfer and were more likely to receive a palliative care consult. Code status differed significantly by documentation quality: patients with better GOC documentation were more likely to have DNAR orders and more likely to experience a code status change within 24 hours of ICU transfer.<br /><br />The authors conclude that physicians infrequently document the essential components of high-quality GOC conversations in ill hospitalized adults before ICU transfer. Older, sicker patients with longer pre-ICU stays tend to have better documentation, but overall practice remains inconsistent. More research is needed to understand why documentation quality is low and how it affects patient care and outcomes.

Asset Subtitle

Natalia Painter

Meta Tag

Author List Emily L. Jacobson, Natalia Painter, Thomas N. O'Callaghan

Category Research

Concept Serious Illness Conversation

Concept Goals-of-Care Documentation

Concept ICU Transfer

Concept Patient Values

Concept Patient Goals

Distinguished Non-Finalist

Presenter Organization University of Michigan

Presenting Author Natalia Painter

Track Communication

Keywords

goals of care documentation

ICU transfer

retrospective study

hospitalized adults

general medicine

palliative care consult

code status

dementia

metastatic cancer

durable power of attorney

Serious Illness Conversation

Goals-of-Care Documentation

ICU Transfer

Patient Values

Patient Goals