Exploring and reconciling discordance between documented and preferred resuscitation preferences for hospitalized patients: a quality improvement study

A discordance, predominantly towards overtreatment, exists between patients’ expressed preferences for life-sustaining interventions and those documented at hospital admission. This quality improvement study sought to assess this discordance our institution. Secondary objectives were explore if internal medicine (IM) teams could identify patients who might benefit from further conversations the can be reconciled in real-time. Two registered nurses incorporated into IM a tertiary conduct resuscitation preference with inpatients either specifically referred them (group I, n = 165) or randomly selected II, 164) 1 August 2016 31 2018. Resuscitation communicated prompting revised orders where appropriate. Multivariable logistic regression was used determine potential risk factors discordance. Three hundred twenty-nine evaluated mean (standard deviation) age of 80 (12) Charlson Comorbidity Index Score 6.8 (2.6). Discordance identified 63/165 (38%) 27/164 (16%) groups I II respectively. 42/194 (21%) did not want cardiopulmonary (CPR) 15/36 (41%) prefer intensive care unit (ICU) admission, despite these having been indicated their initial preferences. 93% (84/90) preferred de-escalation care. 77% (69/90) patients. Hospitalized may have CPR ICU contrary Trained would in-depth conversations. Once identified, during index