Chapter 5 106 psychological burden.16–18Unequivocal code status documentation is of utmost importance to prevent undesirable treatment, especially in a pandemic setting with high pressure on healthcare resources. Therefore, we aimed to describe how this pandemic has impacted the occurrence of code status documentation and discussion. In this study, we describe code status documentation, discussion and frequency of treatment limitations documented in two cohorts: patients admitted with COVID-19 during the first wave of the pandemic, and a previous cohort of patients admitted with (suspected) infection. The results might help us to guide future practice regarding code status discussion. 2. Methods 2.2 Study context This descriptive, retrospective study was conducted in the University Medical Centre of Utrecht (UMCU), a tertiary care teaching medical centre in the Netherlands. The UMCU has 1042 hospital beds, over 11 000 employees, and in 2019,a total of 29 000 admissions. All patient information is documented in the EHR. The EHR includes a form for code status. The quality standards of the Dutch association for Internal Medicine demand a code status is documented in every admitted patient.19 To complete a code status form, mandatory questions are if and which treatment limitations are in place and whether this is discussed with the patient and/or family. Treatment limitations are divided in ‘no resuscitation’, ‘no intubation’, ‘no ICU admission’ and ‘other limitation’, the last one accompanied by a free form question for specification. 2.3 Patient and public involvement statement It was not applicable or possible to involve patients or the public in the design, or conduct, or reporting, or dissemination plans of our research. 2.4 Study population For this study, we combined data from two existing databases.20 Data from COVID-19 patients were extracted from the COVPACH cohort, which consists of all patients >18 years old admitted to the UMCU through the emergency department (ED) or directly on the ward with a positive COVID-19 PCR test from March 2020 to June 2020. Patients immediately transferred from an ICU of another hospital to our ICU were excluded for our analysis. Patients
RkJQdWJsaXNoZXIy MTk4NDMw