Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Zolin, Samuel J.; Bhangu, Jasmin K.; Young, Brian T.; Posillico, Sarah E.; Ladhani, Husayn A.; Claridge, Jeffrey A.; Ho, Vanessa P.
• Is Part Of: American surgeon. Volume 87:Issue 9(2021)
• Page Start: 1488
• Page End: 1495
• Publication Date: 2021-09
• Subjects: critical care -- billing -- trauma -- surgical palliative care -- documentation; Surgery -- Periodicals; Surgery -- United States -- Periodicals; 617.0973
• DOI: 10.1177/0003134820972989
• Languages: English
• ISSNs: 0003-1348

Abstract

Background: Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods: Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results: Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions: Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.