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Background: Medical residents frequently participate in code status discussions, yet their competency in this role has not been evaluated. Purpose: The objective is to determine the quality of code status discussions from the perspective of both resident and patient. Methods: We conducted a cross-sectional survey of consecutive pairs of hospitalized patients and admitting residents at Mayo Clinic in March 2007. We measured perceptions of occurrence and content of code status discussions, admission volume, and demographic information. Results: Among the 41 matched pairs, residents and patients agreed that a code status conversation occurred in 63% of cases. Agreement was more likely if residents performed less than 4 admissions (p= .02). Patients reported the inclusion of specific discussion components, such as resuscitation procedures (7%) and outcomes (0%), less frequently than residents (71% and 27%, respectively, p< .001). Conclusions: Residents and patients demonstrated poor agreement on the occurrence and components of code status conversations. Residency programs should identify ways to enhance residents' competency in eliciting patients' code status preferences and provide adequate time for code status discussions. [ABSTRACT FROM AUTHOR]

Abstract: The do-not-resuscitate order, introduced nearly a half century ago, continues to raise questions and controversy among health care providers and patients. In today''s society, the expectation and availability of medical interventions, including at the end of life, have rendered the do-not-resuscitate order particularly relevant. The do-not-resuscitate order is the only order that requires patient consent to prevent a medical procedure from being performed; therefore, informed code status discussions between physicians and patients are especially important. Epidemiologic studies have informed our understanding of resuscitation outcomes; however, patient, provider, and institutional characteristics account for great variability in the prevalence of do-not-resuscitate orders. Specific strategies can improve the quality of code status conversations and enhance end-of-life care planning. In this article, we review the history, epidemiology, and determinants of do-not-resuscitate orders, as well as frequently encountered questions and recommended strategies for discussing this important topic with patients. [Copyright &y& Elsevier]