Periprocedural Code Status Discussions for Inpatients Undergoing Percutaneous Gastrostomy Tube Placement (S836)

1.Describe recommendations for “Do-Not-Resuscitate” orders in the periprocedural period.2.Discuss current low rate of documented periprocedural code status conversations for patients undergoing inpatient G-tube placement. Gastrostomy tube (G-tube) placement is a common procedure performed for patients with life-limiting diseases. Patients may present for G-tube with a “Do-Not-Resuscitate” (DNR) order. Despite multiple national societies recommending periprocedural conversations for patients with a DNR status, it is not clear how often these conversations occur. We sought to evaluate the frequency of documented code status conversations for inpatients who are DNR at the time of G-tube placement at an academic medical center. We also explored factors associated with the presence of a documented conversation. We performed a retrospective chart review for adult in patients undergoing G-tube placement between May 2016 and May 2017. We abstracted demographic information, type of G-tube inserted, code status, indication for G-tube and mortality data. For patients with a code status other than “Full” at time of G-tube, notes five days pre- and post-procedure were reviewed for documentation of a code status discussion. We identified 254 adult inpatients who underwent G-tube placement during the one-year study period. 101/254 patients (44%) were 66 or older, 62% were male and more than half had the highest severity of illness. The most common indication for G-tube was dysphagia/aspiration (23% of patients). Thirty-three (13%) had code status other than “Full” at the time of procedure. Of those, 9 (27%) had documented code status discussion. Patients for whom anesthesia was involved were significantly more likely to have a documented code status discussion (89% of patients with an anesthesia consult vs. 33% of patients without; p=.0057). The majority of patients with code status other than “Full” at the time of procedure did not have documented discussions in the chart despite clear recommendations from major medical societies.