CLINICAL QUESTION: What are the characteristics of inpatient code status discussions, and how can they be improved?
BACKGROUND: Code status discussions are highly prevalent and encouraged in the inpatient setting. The characteristics of these discussions vary among physicians, and there is room for improvement to ensure concordance with patients’ values.
STUDY DESIGN: A retrospective cohort study
SETTING: Four medical centers affiliated with the University of Toronto
SYNOPSIS: Of the encounters with a documented code status discussion, 26% (29 patients) involved physician recommendations. These recommendations ranged from passive suggestions, where the decision was ultimately deferred to the patient or surrogate, to the physicians actively not offering certain interventions, such as resuscitation. The study also found that the rationale used for providing treatment recommendations generally fit into one of two categories: poor prognosis and alignment with patient goals. Furthermore, the term “quality of life” was used frequently in these code discussions. This term was usually used in contrast to “quantity of life” and/or to portray a poor prognosis. There was a clear lack of documentation of the patients’ specific values when discussing their quality of life.
BOTTOM LINE: Treatment recommendations found in code status discussions typically involved de-escalation of care or restricting invasive interventions. The term “quality of life” was used frequently to justify these recommendations, although there was an absence of details on what this term meant for the patients.
CITATION: Melvin RG, et al. Characterizing physician recommendations within code status documentation: a multicentre cohort study and qualitative discourse analysis. J Gen Intern Med. 2025. doi: 10.1007/s11606-025-09402-z.
Dr. Kwak
Dr. Kwak is a hospitalist and an assistant clinical professor of medicine at UC San Diego Health in San Diego.