Preoperative Code Status Discussion Workflows: Targets for Improvement in Multidisciplinary Pathways

Sashini Godage; Katie Rowe; Frances Y Hu; Angela M Bader; Zara Cooper; Rachelle E Bernacki; David L Hepner; Matthew B Allen

doi:10.1016/j.jpainsymman.2023.03.010

Preoperative Code Status Discussion Workflows: Targets for Improvement in Multidisciplinary Pathways

J Pain Symptom Manage. 2023 Jul;66(1):e35-e43. doi: 10.1016/j.jpainsymman.2023.03.010. Epub 2023 Apr 5.

Authors

Sashini Godage¹, Katie Rowe², Frances Y Hu³, Angela M Bader⁴, Zara Cooper⁵, Rachelle E Bernacki⁶, David L Hepner⁷, Matthew B Allen⁸

Affiliations

¹ Harvard Medical School (S.G., K.R.), Boston, Massachusetts, USA.
² Harvard Medical School (S.G., K.R.), Boston, Massachusetts, USA; Harvard Business School (K.R.), Boston, Massachusetts, USA.
³ Department of Surgery (F.Y.H., Z.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Center for Surgery and Public Health (A.M.B., Z.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Anesthesiology (A.M.B., D.L.H., M.B.A), Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Surgery (F.Y.H., Z.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Surgery and Public Health (A.M.B., Z.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Psychosocial Oncology and Palliative Care (R.E.B), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA; Division of Palliative Medicine, Department of Medicine (R.E.B), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Anesthesiology (A.M.B., D.L.H., M.B.A), Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Department of Anesthesiology (A.M.B., D.L.H., M.B.A), Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: mallen13@partners.org.

PMID: 37023833
DOI: 10.1016/j.jpainsymman.2023.03.010

Abstract

Context: Discussion of perioperative code status is an important element of preoperative care and a component of the American College of Surgeons' Geriatric Surgery Verification (GSV) program. Evidence suggests code status discussions (CSDs) are not routinely performed and are inconsistently documented.

Objectives: Because preoperative decision making is a complex process spanning multiple providers, this study aims to utilize process mapping to highlight challenges associated with CSDs and inform efforts to improve workflows and implement elements of the GSV program.

Methods: Using process mapping, we detailed workflows relating to (CSDs) for patients undergoing thoracic surgery and a possible workflow for implementing GSV standards for goals and decision-making.

Results: We generated process maps for outpatient and day-of-surgery workflows relating to CSDs. In addition, we generated a process map for a potential workflow to address limitations and integrate GSV Standards for Goals and Decision Making.

Conclusion: Process mapping highlighted challenges associated with the implementation of multidisciplinary care pathways and indicated a need for centralization and consolidation of perioperative code status documentation.

Keywords: Advance care planning; code status; decision-making; geriatric surgery verification program; process mapping; serious illness communication.

MeSH terms

Aged
Documentation*
Humans
Outpatients*
Workflow