Highlights
- •The use of a checklist improved protocol adherence for diagnosis of death by neurologic criteria/brain death and did not increase time to declaration of death.
- •Metabolic and toxic confounders are common to encounter in patients who progress to death by neurologic criteria/brain death.
- •The clinical diagnosis of death by neurologic criteria/brain death is commonly limited by the inability to complete apnea testing, and these cases require appropriate ancillary testing.
Abstract
Objective
To determine the effect on adherence to an institutional death by neurological criteria/brain
death (DNC/BD) policy of implementation of a standardized DNC/BD checklist in the
electronic medical record (EMR).
Methods
The retrospective study cohort included all patients admitted to our institution who
were declared dead by neurologic criteria determined by ICD code (G93.82) between
June 2015 and October 2019. Two investigators independently reviewed each case for
adherence with institutional policy, and agreement was assessed using unweighted kappa
statistics. Patient data and adherence to institutional policy before and after implementation
of a standardized DNC/BD checklist were compared.
Results
There were 66 patients identified by the initial search and 38 were included in the
final analysis, with 19 cases in both the pre- and post- checklist periods. There
were no significant differences in age, cause of DNC/BD, time to DNC/BD determination,
potential toxic, metabolic, physiologic confounders, or use of ancillary testing.
The pre-checklist period adherence was 47.4% (n = 9/19) versus 94.6% (n = 18/19; p = 0.001)
in the post-checklist EMR DNC/BD period.
Conclusion
Implementation of a standardized EMR checklist substantially improved DNC/BD policy
adherence in our institution.
Classification of Evidence
This study provides Class IV evidence on the use of standardized EMR checklist to
improve death by neurologic criteria/brain death policy adherence.
Keywords
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References
Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. A definition of irreversible coma: report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA. 1968;205:337-340.
Defining Death: Medical, Legal and Ethical Issues in the Determination of Death [Internet]. Washington, DC: Georgetown University; 1981; available at: https://repository.library.georgetown.edu/bitstream/handle/10822/559345/defining_death.%20pdf?sequence=1. Accessed Nov 10, 2020.
- Variability in reported physician practices for Brain Death determination.Neurology. 2019; 92: e888-e894
- Practice variability in brain death determination: a call to action.Neurology. 2013; 81: 2009-2014
- Variability in diagnosing brain death at an academic medical center.Neurosci J. 2017; 2017: 1-7
- Diagnosis Brain Death: The importance of documenting clinical test results.Anaesthesia. 1999; 54: 81-83
- An evaluation of brainstem death documentation: the importance of full documentation.Pedia Anesthesia. 2004; 14: 584-588
- Brain Death documentation: analysis and issues.Neurosurgery. 2002; 51: 731-735
- Determination of death by neurological criteria round the world.Neurology. 2020; 95: e299-e309
Wijdicks EFM, Varelas PN, Gronseth GS, et al. Evidence-based guideline update: Determining brain death in adults. 2010;74(23):1911-8.
- Quality improvement in neurology: Inpatient and emergency care quality set.Neurology. 2017; 89: 730-735
SL Schafer. StanpumpR. Available at <stanpumpr.io>. Copyright 2019. Accessed on Feb. 4 2021.
- Society for Endocrinology Clinical Guidance: Inpatient management of cranial diabetes insipidus.Endocr Connect. 2018; 7: G8-G11
- Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.Crit Care. 2004; 8: R204-R212
- ACG clinical guideline: evaluation of abnormal liver chemistries.Am J Gastroenterol. 2017; 112: 18-35
- Clinical biostatistics. LIV. The biostatistics of concordance.Clin Pharmcol Ther. 1981; 29: 111-123
- Outcomes and implications of a single brain death exam policy on organ donation outcomes at a high-volume trauma center.J Trauma Acute Care Surg. 2020;
- Safe Surgery Saves Lives study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Eng.J Med. 2009; 360: 491-499
- An intervention to decrease catheter related bloodstream infections in the ICU.N Engl J Med. 2006; 355: 2725-2732
- SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes.N Engl J Med. 2010; 363: 1928-1937
Article info
Publication history
Accepted:
November 17,
2022
Received in revised form:
October 11,
2022
Received:
May 15,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
