Increasing Resuscitation Status Related Goals of Care Discussions for Older Adults at a Canadian Mental Health Hospital
Author(s): Cristina de Lasa, Elnathan Mesfin1 Tania Tajirian, Caroline Chessex, Brian Lo, Sanjeev Sockalingam
Description:
The Geriatric Admission Units (GAU) at the Centre for Addiction and Mental Health comprises older adults with severe mental illness including advanced dementia (AD) who request comfort care focusing on quality of life and avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR).
Before 2019, there was no standardized electronic health record (EHR) resuscitation status related (RSR) documentation tool, and hospital policy did not include resuscitation status order (RSO) with different do-not-resuscitate levels. Physicians would enter a ‘NO CPR’ order within the EHR knowing that non-CPR medical issues would necessitate transfer to acute care, resulting in frequent transfers not in alignment with patients’ voiced wishes.
We aimed to increase GAU RSR-GOCD completion rates by 1 week of admission or transfer to 75% by December 2022. We developed an EHR RSO, updated hospital policy, and provided staff education. We conducted a retrospective chart review over a 4-year period of GAU RSR-GOCD frequency and time to completion, and an environmental scan to identify RSR-GOCD contributing factors, and barriers. RSR-GOCD mean completion rates were 13.4% and mean completion time was 39.6 days. Subgroup analysis demonstrated AD RSR-GOCD completion rates of 20% versus 11% in non-AD patients. Identified RSR-GOCD barriers included lack of an EHR documentation tool and clear triggers.
RSR-GOCD completion rates were lower and took longer than expected, illustrating an opportunity for improvement, while subgroup analysis demonstrated provider understanding of RSR-GOCD importance in frail patients. Next steps include EHR informatics changes including RSO and RSR-GOCD documentation tool integration and modified resuscitation status default language.