Eliminating "Partial Resuscitation": A System-Wide Approach to CPR Status Standardization

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Cardiopulmonary resuscitation requires immediate implementation without patient consultation, yet the decision to forgo CPR is a critical expression of patient autonomy. The Joint Commission mandates clear code status policies to protect this negative right, however national studies demonstrate wide variation in code status documentation across institutions. Prior to 2026, our hospital system lacked standardized CPR status policies and documentation options, contributing to a national problem of unclear documentation, safety concerns, and inconsistent interpretation during emergencies. This review describes ethical requirements, design considerations, implementation tips, and early results following implementation of a standardized CPR status policy.

We conducted a system-wide quality improvement initiative across nine hospital sites with an average daily census of 5,300 patients. The hospital system previously operated under several site-specific CPR policies, including six ambiguous CPR status options such as temporary full resuscitation during invasive procedures, or "partial resuscitation" with exclusion of specific interventions. The new policy contained four clearly defined categories: (1) Full CPR, (2) Do Not Perform CPR but May Intubate, (3) Do Not Perform CPR and Do Not Intubate, and (4) Comfort Care. A multidisciplinary implementation team delivered education through specialty-specific champion-led sessions, educational material, nurse practice council presentations, and unit huddles. Primary outcomes included time to legacy order elimination and whether code status was reassessed with changes in a patient's clinical status. Safety outcomes included monitoring for inappropriate resuscitation attempts.

Legacy code status orders demonstrated rapid washout across the health system. On implementation day, 38 patients retained old code status orders, decreasing to 25 patients on post implementation day (PID) 1, 16 patients on PID 2, and 7 patients on PID 3, reaching near-complete conversion by one week. Hospital sites with more complex organizational structures required additional time to wash out.

Standardized CPR status documentation facilitated by multidisciplinary change management achieved rapid adoption within one week across nine hospitals, demonstrating strong clinician engagement. Simplifying six variably-defined options to four clear categories maintained flexibility while addressing ethical and logistical concerns about code status variation. This implementation demonstrates that systematic policy change can improve ethical clarity, satisfy multiple stakeholders, and occur efficiently without compromising patient safety during transition.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2149

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