TY - JOUR
T1 - Increasing Quality and Frequency of Goals-of-Care Documentation in the Highest-Risk Surgical Candidates
T2 - One-Year Results of the Surgical Pause Program
AU - Oyekan, Anthony A.
AU - Lee, Joon Y.
AU - Hodges, Jacob C.
AU - Chen, Stephen R.
AU - Wilson, Alan E.
AU - Fourman, Mitchell S.
AU - Clayton, Elizabeth O.
AU - Njoku-Austin, Confidence
AU - Crasto, Jared A.
AU - Wisniewski, Mary Kay
AU - Bilderback, Andrew
AU - Gunn, Scott R.
AU - Levin, William I.
AU - Arnold, Robert M.
AU - Hinrichsen, Katie L.
AU - Mensah, Christopher
AU - Hogan, Macalus V.
AU - Hall, Daniel E.
N1 - Publisher Copyright:
© 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.
PY - 2023/4/24
Y1 - 2023/4/24
N2 - Background:Patient values may be obscured when decisions are made under the circumstances of constrained time and limited counseling. The objective of this study was to determine if a multidisciplinary review aimed at ensuring goal-concordant treatment and perioperative risk assessment in high-risk orthopaedic trauma patients would increase the quality and frequency of goals-of-care documentation without increasing the rate of adverse events.Methods:We prospectively analyzed a longitudinal cohort of adult patients treated for traumatic orthopaedic injuries that were neither life-nor limb-Threatening between January 1, 2020, and July 1, 2021. A rapid multidisciplinary review termed a "surgical pause" (SP) was available to those who were ≥80 years old, were nonambulatory or had minimal ambulation at baseline, and/or resided in a skilled nursing facility, as well as upon clinician request. Metrics analyzed include the proportion and quality of goals-of-care documentation, rate of return to the hospital, complications, length of stay, and mortality. Statistical analysis utilized the Kruskal-Wallis rank and Wilcoxon rank-sum tests for continuous variables and the likelihood-ratio chi-square test for categorical variables.Results:A total of 133 patients were either eligible for the SP or referred by a clinician. Compared with SP-eligible patients who did not undergo an SP, patients who underwent an SP more frequently had goals-of-care notes identified (92.4% versus 75.0%, p = 0.014) and recorded in the appropriate location (71.2% versus 27.5%, p < 0.001), and the notes were more often of high quality (77.3% versus 45.0%, p < 0.001). Mortality rates were nominally higher among SP patients, but these differences were not significant (10.6% versus 5.0%, 5.1% versus 0.0%, and 14.3% versus 7.9% for in-hospital, 30-day, and 90-day mortality, respectively; p > 0.08 for all).Conclusions:The pilot program indicated that an SP is a feasible and effective means of increasing the quality and frequency of goals-of-care documentation in high-risk operative candidates whose traumatic orthopaedic injuries are neither life-nor limb-Threatening. This multidisciplinary program aims for goal-concordant treatment plans that minimize modifiable perioperative risks.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Background:Patient values may be obscured when decisions are made under the circumstances of constrained time and limited counseling. The objective of this study was to determine if a multidisciplinary review aimed at ensuring goal-concordant treatment and perioperative risk assessment in high-risk orthopaedic trauma patients would increase the quality and frequency of goals-of-care documentation without increasing the rate of adverse events.Methods:We prospectively analyzed a longitudinal cohort of adult patients treated for traumatic orthopaedic injuries that were neither life-nor limb-Threatening between January 1, 2020, and July 1, 2021. A rapid multidisciplinary review termed a "surgical pause" (SP) was available to those who were ≥80 years old, were nonambulatory or had minimal ambulation at baseline, and/or resided in a skilled nursing facility, as well as upon clinician request. Metrics analyzed include the proportion and quality of goals-of-care documentation, rate of return to the hospital, complications, length of stay, and mortality. Statistical analysis utilized the Kruskal-Wallis rank and Wilcoxon rank-sum tests for continuous variables and the likelihood-ratio chi-square test for categorical variables.Results:A total of 133 patients were either eligible for the SP or referred by a clinician. Compared with SP-eligible patients who did not undergo an SP, patients who underwent an SP more frequently had goals-of-care notes identified (92.4% versus 75.0%, p = 0.014) and recorded in the appropriate location (71.2% versus 27.5%, p < 0.001), and the notes were more often of high quality (77.3% versus 45.0%, p < 0.001). Mortality rates were nominally higher among SP patients, but these differences were not significant (10.6% versus 5.0%, 5.1% versus 0.0%, and 14.3% versus 7.9% for in-hospital, 30-day, and 90-day mortality, respectively; p > 0.08 for all).Conclusions:The pilot program indicated that an SP is a feasible and effective means of increasing the quality and frequency of goals-of-care documentation in high-risk operative candidates whose traumatic orthopaedic injuries are neither life-nor limb-Threatening. This multidisciplinary program aims for goal-concordant treatment plans that minimize modifiable perioperative risks.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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U2 - 10.2106/JBJS.OA.22.00107
DO - 10.2106/JBJS.OA.22.00107
M3 - Article
AN - SCOPUS:85158051861
SN - 2472-7245
VL - 8
JO - JBJS Open Access
JF - JBJS Open Access
IS - 2
M1 - e22.00107
ER -