Code Status Video in the Intensive Care Unit: Video Assisted Patient Education

After randomization subjects will be divided into control group and intervention group that
will receive video tutorial. All subjects will have unlimited access to printed brochures
about Advance Directives available at our institution. Use of those materials will be left
to their discretion of patients, surrogates and health care professionals involved in
patients care. This study was conducted in the medical ICU of tertiary medical center.

Educational video tutorial to cardiovascular resuscitation, defibrillation, endotracheal
intubation and mechanical ventilation. Video presents illustrations of resuscitation
performed on actors. It informs about the risk, benefits and statistical outcomes of CPR.

Immediately after admission to ICU patients or their health care surrogates were asked to
participate in the study. The time between admission and enrollment varied depending on
patient's needs and feasibility of conducting research. Upon enrollment subjects were
stratified into two groups. One was composed of patients participating in education and
testing and another composed of health care surrogates participating on patient's behalf.
Those groups were further divided to intervention group that received video education and
control group. Stratified randomization occurred according to computer generated list which
will be followed for duration of the study. Patients in all four groups had access to
printed brochures about Advance Directives. Those pamphlets were available at the admission
desk and at the nursing stations. All participants were tested from their knowledge of the
code status and related terminology. Subjects randomized to the control group were tested
immediately after obtaining consent. Subject from intervention group were tested immediately
after video education. Test was administered by the investigator in the format of interview.
Completion of the questionnaire took <10 minutes. Questionnaire contained 17 testing
questions. Questionnaire was validated and piloted prior to actual trial.

Satisfaction from education as well as level of discomfort caused by participation in the
study were assessed with numeric scales. Following the interview all participants were asked
if they would like to discuss Code Status preferences with physician taking care of them. If
so, response were noted and appropriate services will be notified immediately. If patients
were unable to consent to the study or participate in video education and testing, their
health care surrogates were allowed to participate on behalf of the patient. Person giving
the consent participated as a subject. Participation of health care proxy were tracked in
the collected data. Patient's medical record number was used as personalized code for all
the subjects including health care surrogates.

Inclusion Criteria:

- Patients ages 18 and older admitted to the medical intensive care unit

Exclusion Criteria:

- Institutionalized status (prisoners)

- Pregnancy

- A priori decided comfort care measures