Thread by @laxswamy

Does every admitted patient need a code status discussion? @AvrahamCooperMD and I propose a more individualized & patient centered approach. The current 'checkbox' practice leads to superficial discussions & inaccurate code status determinations.
sciencedirect.com/science/articl…

Both @AvrahamCooperMD & I have thought about this quite a bit since we were interns. I still remember residents asking me after I presented an H&P for a low acuity admit, "did you remember to ask code status?" not because it was clinically relevant, but because it was a To Do ✅

It isn't uncommon for me to hear from floor patients admitted overnight, "am I going to die?" not because they are so sick but because they were so scared because of the sudden code status discussion the night before. We can cause a lot of fear and anxiety if we're not careful!

Code status discussions are SO important. SO powerful. SO easy to mess up, and require SO much time and care to do well. Treating them as a ✅and expecting that we all apply them routinely- often as an afterthought at the end of an admission H&P- is a setup for errors and harm.

Patients are particularly sick & exhausted when they're admitted to the floors- often after a long ED stay, treatments may not have had time to kick in yet, pain is uncontrolled, etc. They're tired, it is 2am! If you're going to do it, do it because it's important & urgent.

Code status discussions doesn't often address the importance of deeper goals of care. We worry that treating it as a ✅ for everyone avoids more important discussions that so many pts need & deserve.
Check out our piece, looking forward to your thoughts! sciencedirect.com/science/articl…

Oh and of course a huge THANK YOU to @tony_breu and @gbosslet who helped make this piece what it is today! 🙏🏾

Another way of looking at this: saying you're doing a code status discussion for every admission not only doesn't achieve the objective of doing it well for when it matters most ... it actually makes that harder.