The effect of patient code status on surgical resident decision making: A national survey of general surgery residents

Multiple studies have demonstrated that, compared with their full code counterparts, patients with do-not-resuscitate or do-not-intubate status have higher in-hospital and postdischarge mortality than predicted by clinical characteristics alone. We sought to determine whether patient code status aff...

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Veröffentlicht in:Surgery 2020-02, Vol.167 (2), p.292-297
Hauptverfasser: Neufeld, Miriam Y., Sarkar, Bedabrata, Wiener, Renda Soylemez, Stevenson, Elizabeth K., Narsule, Chaitan K.
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container_end_page 297
container_issue 2
container_start_page 292
container_title Surgery
container_volume 167
creator Neufeld, Miriam Y.
Sarkar, Bedabrata
Wiener, Renda Soylemez
Stevenson, Elizabeth K.
Narsule, Chaitan K.
description Multiple studies have demonstrated that, compared with their full code counterparts, patients with do-not-resuscitate or do-not-intubate status have higher in-hospital and postdischarge mortality than predicted by clinical characteristics alone. We sought to determine whether patient code status affects surgical resident decision making. We created an online survey that consisted of 4 vignettes, followed by 10 questions regarding decisions on possible diagnostic and therapeutic interventions. All program directors of Accreditation Council for Graduate Medical Education–accredited general surgery residencies were randomized to receive 1 of 2 survey versions that differed only in the code status of the patients described, with requests to distribute the survey to their residents. Responses to each question were based on a Likert scale. A total of 194 residents completed the survey, 51% of whom were women, and all years of surgical residency were represented. In all vignettes, patient code status influenced perioperative medical decisions, ranging from initiation of dialysis to intensive care unit transfer. In 2 vignettes, it affected decisions to proceed with indicated emergency operations. When presented with patient scenarios pertaining to clinical decision making, surgical residents tend to assume that patients with a do-not-resuscitate or do-not-intubate code status would prefer to receive less aggressive care overall. As a result, the delivery of appropriate surgical care may be improperly limited unless a patient’s goals of care are explicitly stated. It is important for surgical residents to understand that a do-not-resuscitate or do-not-intubate code status should not be interpreted as a “do-not-treat” status.
doi_str_mv 10.1016/j.surg.2019.07.002
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source MEDLINE; Access via ScienceDirect (Elsevier)
subjects Adult
Cross-Sectional Studies
Female
General Surgery
Humans
Internship and Residency
Male
Resuscitation Orders - psychology
Surgeons - psychology
Surgeons - statistics & numerical data
Young Adult
title The effect of patient code status on surgical resident decision making: A national survey of general surgery residents
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