Incidence of Unconfirmed Code Status Documentation in Surgical Patients with Preoperative Medical Orders for Life Sustaining Treatment (MOLST).

Abstract

To investigate prevalence of unconfirmed code statuses among surgical patients presenting with MOLST forms. Confirming code status is critical to preoperative planning for high-risk patients. Patients may present with documented preferences, such as Medical Orders for Life Sustaining Treatment (MOLST) forms. However, some electronic health records (EHR) allow for unconfirmed code status orders, such as "Full Code Presumed" and "No Code Status." This study includes patients with preexisting MOLST forms who underwent operating room procedures at a tertiary care center over a one-year period. Chart review was used to measure frequency and duration of unconfirmed code status orders, as well as to extract the circumstances of order placement. Of 402 patients meeting inclusion criteria, 92.5% held at least one unconfirmed code status during their encounter. The median total time a patient spent with an unconfirmed order was 48.7 hours (IQR 9.0-122.6). 52.6% of admitted patients were discharged with an unconfirmed code status. Two patients died with the order "full code presumed" in place. 54.3% of patients with unconfirmed code statuses had presented with MOLST forms indicating no CPR and/or no intubation. Patients were most at risk of an unconfirmed code status during admission and on the day of surgery. Use of unconfirmed code status orders was nearly universal in this surgical population, indicating that even patients with preexisting documented preferences are at risk of code status ambiguity in the EHR. To ensure goal-concordant care, interventions must target early code status confirmation for this vulnerable population.