Simplify and reduce the number of code status options.

Reframe resuscitation as an attempt at CPR rather than a procedure likely to restore life.

Replace ‘Do Not Resuscitate (DNR)’ with ‘Do Not Attempt Resuscitation (DNAR)’.

Simplify code status choices to three options: DNAR, DNAR/OK to Intubate; and Full Code.

Patient-reported understanding of resuscitation options.

Percentage of high-risk patients with resuscitation status as DNAR or DNAR/OK to Intubate.

Eliminate inconsistent code status options including ‘Full Code, Do Not Intubate’.

Standardised code status order entry.

Widely understood periprocedural resuscitation policies.

Code status reconciliation across clinical encounters.

Develop and implement procedural resuscitation orders that demand timed Full Code order expiration for procedural DNR reversals.

Include guideline-based code status recommendations to preprocedural checklists.

Implement EHR interruptive alerts to reconcile code status order discrepancies AND guide clinicians to perform serious illness conversation for high-risk patients.

Frequency of code status orders on hospital admission and periprocedurally resuscitation preference (compared with MOLST or documented SIC).

Frequency of periprocedural resuscitation status errors.

CSDs occur with a majority of high-risk patients in the outpatient setting with longitudinal providers.

Code status confirmed as soon as possible on hospital admission.

Add code status to EHR dashboards and implement decision support tools to guide clinicians to perform and document serious illness conversations in high-risk patients.

Eliminate ‘Presumed’ code status as a durable order on hospital admission.

Frequency of SIC documentation among high-risk patients.

Frequency of resuscitation status confirmed on hospital admission.

 Adopt a common framework for serious illness conversations across the organisation.

 Confident and informed clinicians leading serious illness and code status discussions.

Institutionalise a common serious illness conversation (SIC) framework using the serious illness conversation guide as key tool.

Percentage of SIC trained staff.

Clinician qualitative measure of confidence in conducting code status and SIC.

Develop and implement training for all and preferably VitalTalk simulation-based instruction for select staff (admitting physicians, bedside nurses in ICU, surgical and medical floors).