Case Study: Code Status

One of my experiences as a hospitalist demonstrates what can happen if the predetermined code status is not followed.

Mrs. A was an elderly lady who came into the Emergency Room from a local nursing facility. She was in respiratory distress from congestive heart failure. Apparently the DNR/DNI status was not known at the time and she was intubated immediately to avoid respiratory arrest. I then accepted the patient for admission to the Intensive Care Unit. Shortly thereafter, the daughter arrived and was absolutely livid that her mother had been intubated and placed on a ventilator. An advance directive and DNR, DNI form had been previously activated. Unfortunately, it had not been readily available to those who needed to know when she became acutely ill.

I spent the next 1-2 hours trying to discuss the situation and how it happened with the daughter. The patient was extubated within 1-2 hours of arrival and actually she survived and ultimately was able to be transferred back to the nursing facility a few days later. The daughter remained somewhat angry afterwards, but not as much. I suspect that the time I spent with her, allowing her to vent the anger, may have been helpful in preventing the situation from getting much worse.

This raises the point that, we need to be sure the DNR, DNI information is known and readily available when a patient becomes acutely ill. The second point is to allow the angered relative to vent the frustration when a mistake has been made, and also to try to rectify the problem as quickly as possible.

This page was last updated on October 10, 2010.

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