B38-16 The Impact of an Educational Intervention to Prevent Code Status Bias in Resident Decision Making

Abstract Intro Multiple studies show worse outcomes for patients with do not resuscitate and do not intubate (DNR/DNI) orders as compared to full code patients. Surveys of attending and resident physicians have also revealed significant differences in the treatment choices other than intubation and cardiopulmonary resuscitation (CPR) for patients simply on the basis of code status. This suggests bias towards de-escalation of standard medical care in hospitalized DNI/DNR patients, that may itself contribute to clinical deterioration. We hypothesized that a single practical educational intervention might reduce such bias. Methods A survey was sent to 80 internal medicine residents at a tertiary care center. The survey measured the intention to provide various interventions on a likert scale (very unlikely to provide = -2, very likely to provide = +2) for full code vs DNR/DNI patients in four clinical vignettes. Two versions of the survey (A and B) were administered to control for code status. Before survey administration, we gave a lecture to the residents, which only some were able to attend due to schedule variability. We measured for differences in intention to treat DNR/DNI vs full code patients between those lecture attendees (lecture group) and non-attendees (control group). Qualitative data was also collected. Survey response data for all interventions outside of intubation or CPR was pooled and labeled “basic care.” We used two-tailed T tests to compare lecture and control groups. Results 35 residents completed surveys (control n = 26, lecture n = 9). Survey A had 20 respondents (control =12, lecture=8) and survey B had 15 (control = 14, lecture =1). There was no statistically significant change in the intention to provide basic care to patients following our intervention, with one exception. In clinical vignette 1, the lecture group were significantly more likely to provide basic care to a full code patient. The control group were more likely to mention to consider withholding basic care when describing DNR/DNI code status (4/26 vs 0/9). The lecture group largely reported that the lecture moderately changed their thinking and practices. Common themes in changes to thinking described awareness of bias. Common themes to changes in practice described better documentation of code status discussions and awareness of bias when providing care. Conclusion Educational intervention seems increase self-perceived provider awareness of bias when providing care to DNR/DNI patients; however, in this small study we did not demonstrate this awareness translated into significant changes in care for these patients. This abstract is funded by: None