Dear FAB Colleagues, 

 

The Clinical Ethics Committee at The Sir Mortimer B. Davis Jewish General Hospital in Montreal Canada is revising the hospital's resuscitation policy. The new policy adopts a Levels of Intervention approach. We are quite far along in the project and the policy is now before our Medical Executive Committee for approval. The next step will be Board approval.

We are thinking ahead to implementation and would like to know the experience of other centres who have adopted similar approaches.

Do any of you use a similar approach in your own centres or know of other similar approaches used elsewhere? If so, can you tell me about your experiences with implementing the policy? Or, who I might contact for more information?

Descriptions of the levels we are proposing are copied below. The McGill University Health Centre (also in Montreal Canada) has a similar policy with essentially the same 4 levels. Because students and staff go between our hospital and MUHC, for consistency (and because we like the approach) we kept the same levels. However, we divided level 2 into 2A and 2B to respond to the need to clarify which patients will receive chest compressions while waiting for the code team to arrive. 



I appreciate any assistance you can give me. 
Carolyn Ells

Chair, Clinical Ethics Committee

The Sir Mortimer B. Davis Jewish General Hospital



You can contact me off-list at [log in to unmask]



Levels of Intervention:


Level 1: Provision of maximal interventions offered by the treating
team (including chest compressions, critical care unit transfer). All
patients are assumed to be Level 1, unless medical reasons or patient
preference suggest otherwise.

Level 2A: Provision of maximal interventions with some restrictions.
Chest compressions are to be initiated in the event of cardiopulmonary
arrest. Other restrictions must be specified (for example, intubation,
mechanical ventilation, etc.). Restrictions can relate to specific
situations or procedures.

Level 2B: Provision of maximal interventions with some restrictions,
as described in Level 2A.  In the event of cardiopulmonary arrest,
however, chest compressions are NOT to be initiated.

Level 3: Provision of maximal interventions on the ward aimed at
treating reversible conditions, maintenance of function and comfort
care, but no chest compressions and no transfer to a critical care
unit. Any additional restrictions must be identified (for example,
dialysis, surgery, etc.).

Level 4: Provision of interventions adapted to palliation and patient
comfort. The primary goal of care is comfort. Actions to improve
patient serenity are taken or continued. Interventions are provided for
comfort and dignity only.  This includes relieving or lessening
symptoms without achieving cure, and can include treating some
reversible conditions. No chest compressions. No transfer to a critical
care unit. Instructions regarding treatment of reversible conditions
must be specified.


Carolyn Ells, PhD
Assistant Professor of Medicine
Biomedical Ethics Unit, McGill University
3647 Peel St, Montreal QC H3A 1X1 Canada
Tel: 514-398-2521  Fax: 514-398-8349
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