Chapter 5 110 extent, ‘other limitation’ (17% vs 9%) compared with patients in the before COVID-19 cohort. The frequency of ‘no resuscitation’ was comparable in both cohorts (96% vs 92%). The difference in limitations remained when comparing the COVID-19 patients with only patients with respiratory infections from the before COVID-19 cohort. Figure 1 Prevalence of types of limitations in patients with any limitation admitted before the COVID-19 pandemic and admitted with COVID-19. ICU, intensive care unit. 4. Discussion To broaden our knowledge on code status decision-making in the impactful COVID-19 period, we described code status documentation, discussion and content of code status in a cohort of COVID-19 patients and a cohort of patients prior to the pandemic. Surprisingly, we found similar frequencies of code status documentation on admission in the COVID-19 and the before COVID-19 cohort (69.8% vs 72.7%, respectively). We had expected an increase given the raised attention to disadvantages of ICU admission and shortage of care during the pandemic.4 5 24 Reassuringly, code status documentation did not decrease either, indicating the higher workload during COVID-19 did not reduce the attention to code status documentation. The equal frequency of discussion of code status in the COVID-19 cohort compared with the before COVID-19 cohort (75.6% and 73.3%, respectively, discussed of all documented code status) supports this as well. COVID-19 appears to have led to a more limitation-directed approach: substantially more patients had treatment limitations during the COVID-19
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