Journal of pain and symptom management · 2025
Assessing the Quality and Impact of Goals of Care Documentation Before Intensive Care Unit Transfer.
СтатьяНазвание и аннотация: Перевод в очереди
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Jacobson Emily, O'Callaghan Thomas, Tian Shuo, Shrestha Sachita, Paje David, Taylor Stephanie P, Painter Natalia
Аннотация
CONTEXT: High-quality goals of care (GOC) conversations are essential to providing patient-centered care during clinical deterioration in hospitalized patients. However, the presence and quality of GOC documentation before deterioration events such as intensive care unit (ICU) transfer is unknown.
OBJECTIVES: To evaluate the quality of GOC documentation in hospitalized adults before ICU transfer and assess the association between high-quality documentation and code status change after transfer.
METHODS: We reviewed records of 373 adult medicine patients transferred unplanned to the ICU at a university hospital over 24 months. We collected demographic data, pre-ICU hospitalization characteristics, and code status changes within 24 hours of transfer. The primary outcome was high-quality GOC documentation, defined as the presence of ≥2 of following components: prognosis, values/goals, surrogate decision maker, and intervention preferences. We analyzed data to assess factors associated with high-quality documentation and performed logistic regression to evaluate the relationship between documentation quality and code status changes after ICU transfer.
RESULTS: Few patients (N = 80, 21.4%) had high-quality GOC documentation. The least frequent components documented were values/goals (16.1%) and prognosis (16.9%). Older age, frailty, specific comorbidities, palliative care consultation, longer pre-ICU hospitalization, and DNAR (do-not-attempt resuscitation) or multiple code statuses were associated with high-quality documentation (P < 0.05). High-quality GOC documentation was independently associated with odds of code status change after ICU transfer (OR, 3.41; 95% confidence interval [95% CI], 1.70-6.81).
CONCLUSION: High-quality GOC documentation was present in only one in five patients before ICU transfer and was associated with code status change within 24 hours of transfer.
OBJECTIVES: To evaluate the quality of GOC documentation in hospitalized adults before ICU transfer and assess the association between high-quality documentation and code status change after transfer.
METHODS: We reviewed records of 373 adult medicine patients transferred unplanned to the ICU at a university hospital over 24 months. We collected demographic data, pre-ICU hospitalization characteristics, and code status changes within 24 hours of transfer. The primary outcome was high-quality GOC documentation, defined as the presence of ≥2 of following components: prognosis, values/goals, surrogate decision maker, and intervention preferences. We analyzed data to assess factors associated with high-quality documentation and performed logistic regression to evaluate the relationship between documentation quality and code status changes after ICU transfer.
RESULTS: Few patients (N = 80, 21.4%) had high-quality GOC documentation. The least frequent components documented were values/goals (16.1%) and prognosis (16.9%). Older age, frailty, specific comorbidities, palliative care consultation, longer pre-ICU hospitalization, and DNAR (do-not-attempt resuscitation) or multiple code statuses were associated with high-quality documentation (P < 0.05). High-quality GOC documentation was independently associated with odds of code status change after ICU transfer (OR, 3.41; 95% confidence interval [95% CI], 1.70-6.81).
CONCLUSION: High-quality GOC documentation was present in only one in five patients before ICU transfer and was associated with code status change within 24 hours of transfer.