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Background: Code status discussions (CSDs) in the intensive care unit (ICU) are frequently conducted by resident physicians. Cardiopulmonary resuscitation (CPR) videos when used to aid ICU patients and families in code status decision making have been shown to have a positive impact. The purpose of this study is to evaluate the impact of a CPR video, when made available to supplement trainee?patient CSDs, on ICU residents' comfort level when conducting these discussions. Objectives: To assess whether a CPR video as an intervention tool would increase residents' comfort level when conducting CSDs. Methods: This is a pre- and postintervention pilot study. A presurvey querying details about trainees' comfort level when conducting CSDs was administered to the residents at the beginning of the ICU rotation, and a CPR video was availed to them to supplement their trainee?patient CSDs. A postsurvey was administered to trainees at the end of their ICU rotation to evaluate and analyze the impact of the CPR video on residents' comfort level when conducting trainee?patient CSDs. Results: A total of 118 trainees rotated through the ICU with 43 (36%) answering the presurvey and 28 (24%) answering the postsurvey. Twenty-two (51%) presurvey respondents felt extremely comfortable and 18 (42%) felt somewhat comfortable conducting CSDs. Thirteen (46%) postsurvey respondents felt extremely comfortable and 12 (43%) felt somewhat comfortable conducting CSDs. Most postsurvey respondents (79%) almost never used the video and (67%) neither agree nor disagree that the video was useful. Conclusion: In our small cohort, CPR video when made available to supplement trainee?patient CSDs did not impact resident physicians' comfort level when conducting these discussions. The residents' low level of engagement with this video, among other factors, could explain our results.

Objective: To determine prevalence of documented preoperative code status discussions and postoperative outcomes (specifically mortality, readmission, and discharge disposition) of patients with completed MOLST forms before surgery. Summary of Background Data: A MOLST form documents patient care preference regarding treatment limitations. When considering surgery in these patients, preoperative discussion is necessary to ensure concordance of care. Little is known about prevalence of these discussions and postoperative outcomes. Methods: A retrospective cohort study was conducted consisting of all patients having surgery during a 1-year period at a tertiary care academic center in Boston, Massachusetts. Results: Among 21,787 surgical patients meeting inclusion criteria, 402 (1.8%) patients had preoperative MOLST. Within the MOLST, 224 (55.7%) patients had chosen to limit cardiopulmonary resuscitation and 214 (53.2%) had chosen to limit intubation and mechanical ventilation. Code status discussion was documented presurgery in 169 (42.0%) patients with MOLST. Surgery was elective or nonurgent for 362 (90%), and median length of stay (Q1, Q3) was 5.1 days (1.9, 9.9). The minority of patients with preoperative MOLST were discharged home [169 (42%), and 103 (25.6%) patients were readmitted within 30 days. Patients with preoperative MOLST had a 30-day mortality of 9.2% (37 patients) and cumulative 90-day mortality of 14.9% (60 patients). Conclusions: Fewer than half of surgical patients with preoperative MOLST have documented code status discussions before surgery. Given their high risk of postoperative mortality and the diversity of preferences found in MOLST, thoughtful discussion before surgery is critical to ensure concordant perioperative care. [ABSTRACT FROM AUTHOR]

Abstract Introduction Conducting discussions about code status is a common and important responsibility of clinicians in many specialties. Despite the frequency of these conversations, the teaching that trainees receive in conducting this important communication is highly variable. Traditionally, these skills have been taught through observation and role-play or, more commonly, not taught at all. Direct observation of more experienced providers conducting code status discussions is another important but highly variable educational modality. Role-plays can be useful but are time consuming to arrange and facilitate. In order to address this educational gap, we produced a video tutorial that would allow large numbers of learners to watch simulated patient-clinician interactions, reflect on what they have watched, and hear experts discuss the strengths and weaknesses of these conversations. The target audience is medical students, house staff, and advanced practice nursing students. Methods The tutorial, which takes about an hour to complete, consists of an overview of resuscitation and then a framework for conducting these conversations. The first step is preparation, followed by a discussion of values, a consent process, and finally the summary. The mnemonic device PVCS, for Premature Ventricular ContractionS, helps learners remember this framework. Common pitfalls as well as effective communication techniques are illustrated. Educational modalities include videos of a standardized doctor and/or nurse talking with a patient actor about code status, expert commentary on the videos by nationally renowned palliative care experts, multiple-choice questions with answers, and a customized pocket card that learners print out at the end. Results We are currently conducting a block randomized trial of third-year medical students at the University of California, San Francisco (UCSF), comparing this curriculum to an equivalent written curriculum. Our hypothesis is that a web-based video curriculum will be superior to a written curriculum. The outcome measures are satisfaction with the curriculum, scores on standardized patient checklists, and ability to reflect on conducting these conversations with standardized patients. We have pilot-tested the curriculum extensively at both UCSF and Dartmouth with medical students, advance practice nursing students, and medicine residents. In addition, we have shared the website with other palliative medicine faculty at UCSF, Dartmouth, and Harvard. Discussion The curriculum is useful as an individual tool or as the focus of a small-group session for medical students or residents. Learners find it helpful to be able to discuss the material with peers and faculty. We have also used the curriculum as an introduction to a standardized patient exercise on conducting code status discussions for third-year medical students.

Background: Code status discussions (CSDs) in the intensive care unit (ICU) are frequently conducted by resident physicians. Cardiopulmonary resuscitation (CPR) videos when used to aid ICU patients and families in code status decision making have been shown to have a positive impact. The purpose of this study is to evaluate the impact of a CPR video, when made available to supplement trainee-patient CSDs, on ICU residents' comfort level when conducting these discussions., Objectives: To assess whether a CPR video as an intervention tool would increase residents' comfort level when conducting CSDs., Methods: This is a pre- and postintervention pilot study. A presurvey querying details about trainees' comfort level when conducting CSDs was administered to the residents at the beginning of the ICU rotation, and a CPR video was availed to them to supplement their trainee-patient CSDs. A postsurvey was administered to trainees at the end of their ICU rotation to evaluate and analyze the impact of the CPR video on residents' comfort level when conducting trainee-patient CSDs., Results: A total of 118 trainees rotated through the ICU with 43 (36%) answering the presurvey and 28 (24%) answering the postsurvey. Twenty-two (51%) presurvey respondents felt extremely comfortable and 18 (42%) felt somewhat comfortable conducting CSDs. Thirteen (46%) postsurvey respondents felt extremely comfortable and 12 (43%) felt somewhat comfortable conducting CSDs. Most postsurvey respondents (79%) almost never used the video and (67%) neither agree nor disagree that the video was useful., Conclusion: In our small cohort, CPR video when made available to supplement trainee-patient CSDs did not impact resident physicians' comfort level when conducting these discussions. The residents' low level of engagement with this video, among other factors, could explain our results., Competing Interests: We have no conflict of interest and no financial disclosure., (© Trinh T. Pham et al., 2022; Published by Mary Ann Liebert, Inc.)