JHQ 308: General Surgery Resuscitation Preferences Documentation: A Quality Improvement Initiative-JHQ 308 Article

JHQ 308 Article

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This article describes a quality improvement initiative at a large tertiary care center to improve documentation of perioperative resuscitation preferences (code status) for general surgery patients, an important component of patient autonomy and appropriate care during sudden deterioration. Baseline documentation in the electronic medical record (EMR) within 24 hours of admission was 82% in General Surgery (below the institutional 90% target).<br /><br />Using the Model for Improvement (Langley/IHI), a multidisciplinary team (surgeons, anesthesiologist, ethicists, patient partner, and QI support) conducted root cause analysis and implemented three workflow-based interventions rather than relying on education alone. First, the surgical consent form was redesigned to include a clear resuscitation status section (or an explicit presumption of full code), enabling discussion and capture of preferences at the time of consent in clinic for elective cases or on admission for emergencies. Second, resuscitation status confirmation was added to the routinely used preoperative surgical safety checklist to prompt review. Third, patient-facing educational resources about resuscitation options and processes were revised with input from patient partners and made available in clinics to reduce misconceptions and support informed conversations.<br /><br />The primary outcome—percentage of general surgery patients with resuscitation preferences documented in the EMR within 24 hours—increased from 82% preimplementation to 90% by December 1, 2022, achieving the target (with sustained performance above 90% afterward). Improvements differed by case type: elective cases rose from about 70% to the low 80s, while emergency cases increased from about 89% to the mid-90s.<br /><br />A postintervention audit (119 encounters, 20 surgeons) showed high uptake of the new consent form (90%), moderate checklist use (74%), and infrequent additional narrative documentation (5%). No incorrect documentation was identified. The authors conclude that embedding resuscitation checks into standard forms is a cost-neutral, scalable, and generalizable approach that prompts earlier, higher-quality discussions and improves documentation reliability.

Keywords

perioperative code status

resuscitation preferences documentation

general surgery quality improvement

electronic medical record (EMR) compliance

Model for Improvement (IHI Langley)

surgical consent form redesign

preoperative safety checklist prompt

patient autonomy and informed consent

patient-facing resuscitation education materials

workflow-based interventions sustainability