Code status documentation during the COVID-19 pandemic 107 5 transferred from the general ward or ED of another hospital to our general ward or ED were not excluded. Data of patients admitted before COVID-19 were extracted from the SPACE cohort, which consists of patients above 18 years old with a suspected infection at the ED. The SPACE database has been described in more detail previously.21 For the current analysis, we included only unique patients that were admitted in the hospital, defined as the first presentation with admission. Patients were admitted between September 2016 and September 2018. For both databases, patients were offered a general opt-out for data collection, according to hospital policy. This option is taken by 1.7% of the patients. 2.5 Data collection Baseline characteristics For both cohorts, age and gender were automatically extracted from the EHR along with the first measured clinical parameters necessary to calculate the Modified Early Warning Score (MEWS).22 If the Glasgow Coma Scale was missing, the ED documentation was analysed for information on mental state and manually added accordingly. Manually extracted baseline characteristics were transfer from other hospital, living situation before admission, malignancy and dementia. The other comorbidities needed to calculate the updated Charlson Comorbidity Index (CCI) were also added manually.23 For the ‘before COVID-19’ (SPACE) cohort, type of infection was extracted manually and divided in five groups (respiratory, gastrointestinal, urinary tract, skin and other infections). Classification was based on the ED primary discharge diagnosis. For patients from the ‘COVID-19’ (COVPACH) cohort, type of infection was a COVID-19 infection. Code status The date of code status documentation, presence of any and which treatment limitations and discussion with patient or family were automatically extracted from the EHR. Code status documented on admission was defined as documentation entered in the EHR between 24 hours before and after the date of admission. Earlier or later documentation of code status was regarded as not documented on admission.
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