Official websites use. Share sensitive information only on official, secure websites. Corresponding Author. For older adults with serious, life-limiting illness, the decision to initiate intubation is complex and emotional. With seriously ill older adults in acute respiratory failure, emergency physicians are having some of the hardest conversations in medicine. Emergency physicians recognize this pivotal moment to provide goal-concordant care 8 ; however, the time-pressured environment, lack of longitudinal relationship with patients, and clinical instability further increase the complexity of these conversations.
In this article, we discuss the prognosis of older adults undergoing ED intubation in the context of framing the code status conversations and provide a practical framework to execute these difficult conversations.
Effective code status conversations require emergency physicians to understand the prognosis of seriously ill older adults with acute respiratory failure and rapidly explore what matters most. As with any procedure, the code status conversations are mastered through deliberate practice of communication skills. We recommend reading the following steps out loud Figure 2. Furthermore, we encourage emergency physicians to flexibly adjust the order of the following steps because these conversations may not occur linearly.
ED code status conversation guide. Your [father] is very sick and I have to decide quickly about [his] care. What have you heard about what happened today?
Would it be OK if I talk about it? Asking for permission enables the patient or surrogate a moment to emotionally prepare. Most important, it gives a sense of control in a situation that may feel out of control. With his serious health issues, I am worried that things may not go well, and it is possible [he] could even die. The news is delivered with little jargon. Therapeutic alignment is key to building trust, which is necessary to make a patient-centered recommendation.
