Two Patients Coded

My recent post on end-of-life care issues, “What if they had had to pay?,” generated a lot of comments in the blogosphere and beyond.  One intensive care doctor sent me a particularly poignant note.  It gives a good sense of what it is like on this person’s side of the bed.  The note re-emphasizes the need for better end-of-life planning, for the sake of patients, families, and providers.

Here’s my day so far.  This is my first day of a 7-day stretch in a tertiary ICU. The average census in this ICU is 10, but today we have had to surge to 15.

Let me stop right there.  This is doctor (and nurse) shorthand for, “I expect to be very busy, very tired, and very stressed out.  I am going to have to make some highly critical clinical judgments, sometimes with very little time to react.  I don’t know anything about these patients beyond what is in the charts and what our care team sees and hears for themselves.”

Two patients today coded in our hospital. One family wants “everything” done, and seemed shocked to learn that I don’t think it is right to provide “everything.” The other family wished someone from the healthcare team had bothered to ask them what their 89 year old dad would really like to accomplish from his hospital stay before he tried to die. We decided to let him finish dying.

And I had 3 other similar discussions with patients or their families about goals that can actually be achieved. All of them were already in the ICU, having had no real clear previous discussions. One of those patients was admitted last night, but the other 2 had been in our ICU for days….

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

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  1. As a patient advocate, Dr. Levy ought to work to assure that EHR devices are safe, efficacious, and usable.

    Many patients code for many reasons but there is an uptick in codes during go-lives of HIT CPOE at hospitals from the neglect and distraction from nurses paying more attention to the EHR devices than to the patients.

    If my loved one coded from the neglect associated with EHRs, yes, I want everything done to reclaim life from such a preventable toxictiy.

    It is rarely alert fatigue, but rather, cognitive distraction caused by meaningfully unusable HIT devices.

    My friend was a patient at his former hospital. The top five complaints of this case were neglect, neglect, neglect, neglect, and neglect (in that order) as she saw the nurses with faces glued to the terminal screens. SAD!