• J Pain Symptom Manage · Jul 2023

    Preoperative Code Status Discussion Workflows: Targets for Improvement in Multidisciplinary Pathways.

    • Sashini Godage, Katie Rowe, Frances Y Hu, Angela M Bader, Zara Cooper, Rachelle E Bernacki, David L Hepner, and Matthew B Allen.
    • Harvard Medical School (S.G., K.R.), Boston, Massachusetts, USA.
    • J Pain Symptom Manage. 2023 Jul 1; 66 (1): e35e43e35-e43.

    ContextDiscussion of perioperative code status is an important element of preoperative care and a component of the American College of Surgeons' Geriatric Surgery Verification (GSV) program. Evidence suggests code status discussions (CSDs) are not routinely performed and are inconsistently documented.ObjectivesBecause preoperative decision making is a complex process spanning multiple providers, this study aims to utilize process mapping to highlight challenges associated with CSDs and inform efforts to improve workflows and implement elements of the GSV program.MethodsUsing process mapping, we detailed workflows relating to (CSDs) for patients undergoing thoracic surgery and a possible workflow for implementing GSV standards for goals and decision-making.ResultsWe generated process maps for outpatient and day-of-surgery workflows relating to CSDs. In addition, we generated a process map for a potential workflow to address limitations and integrate GSV Standards for Goals and Decision Making.ConclusionProcess mapping highlighted challenges associated with the implementation of multidisciplinary care pathways and indicated a need for centralization and consolidation of perioperative code status documentation.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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