SHM Converge Scientific Abstract ePoster Gallery-The Impact of the Covid-19 Pandemic and a Covid Unit on Code Status Ordering

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This retrospective cohort study examined how the COVID-19 pandemic affected inpatient code status documentation at the University of Chicago Medical Center from January 2019 to December 2020 (59,471 unique encounters). The authors focused on three questions: whether the pandemic changed code status ordering overall, whether race influenced documentation before and during the pandemic, and whether there were spillover effects among patients who were COVID-negative.<br /><br />Overall, code status documentation increased from 22% before the pandemic to 29% during the pandemic. The increase was much larger among COVID-positive patients, where documentation reached 65%. Among COVID-negative inpatients, documentation also rose from 22% to 27%, suggesting that heightened emphasis on advance care planning during the pandemic affected care beyond patients with COVID-19.<br /><br />The study also found important racial differences. Before the pandemic and during the pandemic among COVID-negative patients, race significantly affected code status ordering. However, among COVID-positive patients, race did not significantly affect whether code status was documented. This suggests that the urgency and clinical uncertainty of COVID-19 may have reduced disparities in documentation for that subgroup, though inequities persisted for other inpatients.<br /><br />During the pandemic, UCMC’s dedicated COVID unit emphasized code status discussion, included it in hand-offs, and incorporated it into the electronic medical record workflow, which likely contributed to the increased documentation rates.<br /><br />The authors conclude that the pandemic improved code status documentation overall and in COVID-related care, but racial disparities remained for non-COVID patients. Next steps include building regression models to assess additional covariates, provider-level effects, and disease acuity.

Asset Subtitle

Ethan Molitch-HoU

Meta Tag

Author List Alexandra Tate, Ethan Molitch-HoU, Hui Zhang, Pooja Gala

Category Research

Concept COVID-19 Pandemic

Concept Code Status Documentation

Concept Hospitalized Patients

Concept Race

Concept Retrospective Cohort Study

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Ethan Molitch-HoU

Track Outcomes Research

Keywords

COVID-19 pandemic

code status documentation

inpatient encounters

retrospective cohort study

advance care planning

racial disparities

COVID-positive patients

COVID-negative patients

electronic medical record

University of Chicago Medical Center

COVID-19 Pandemic

Code Status Documentation

Hospitalized Patients

Race

Retrospective Cohort Study