DC Treatment

DC (discontinuation) of treatment is the termination of life-supportive therapy in an intensive care setting.

We collect DC Treatment for critical care only as a yes/no check-box. On the PDA, check box is on the Reg page. In the CCMDB.mdb the checkbox is on the Reg, ADL and Variables tab.

When to code "DC Treat"

• when the decision is made to discontinue treatment in ICU
• even if Palliative Care (90400) is provided and coded

If the ICU physician DC’s TX (withdraws therapy) on a patient then Transfer ready/discharge date is not needed.

If a patient arrests in your unit and CPR is unsuccessful the date and time of stopping CPR should not be recorded for Transfer ready/discharge date ready.

If an unit physician discontinues TX and a patient is put on the transfer/discharge ready list but unexpectedly passes away prior to being to being moved out of your unit, then the recording of TRANSFER/DISCHARGE READY is appropriate.

Discussion

• Disagree with NOT NEEDING a transfer ready time. This time is needed to account for delays in transfer and availability of beds on the wards.FLindell 13:34, 2 June 2008 (CDT)
• I am not sure if you are referring to the last point above or not. If TX is DC'd and death is not immediate, which is sometimes the case, and a patient put on a bed transfer list, if the patient die before he is transferred out of the ICU

When not to code "DC Treat"

• "DC Treat" is not coded on Medicine wards

Discussion

• This is not true at HSC. We are using the DC treatment code on the Medicine wards. GHall 19:14, 8 May 2008 (CDT)

Other Resources

• http://www.cja-jca.org/cgi/content/abstract/46/5/497 (GM Eschun, E Jacobsohn, D Roberts and B Sneiderman)
  • you can see the FULL TEXT (PDF) if you select this option at the top right of the article on this page.

• Withdrawal of treatment is not the same as withdrawal of care. DC Treatment in an ICU setting occurs because it is often possible to maintain life for long periods of time without any hope of recovery. Intensive care is a means of supporting organ systems and it is not always curative. Prolonging the process of dying is not in the patient's best interests nor is it ethical. (Winter,B. & Cohen,S. (1999). ABC of intensive care. Withdrawal of treatment. BMJ 319, 306-308.)

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Discussion

• Is there an expectation to see DC patients survive their ICU stay? How sure of an expectation? Can this still be checked if the patient survives? Usually DC treatment involves removing life support devices which subsequently results in death. However, occasionally the patient may survive to go to a Palliative care ward and in this event Palliative care should also be coded. --LKolesar 12:54, 8 May 2008 (CDT)

• Our current practice on Medicine at HSC is to use the DC treatment code when treatment is stopped and death is expected imminently. We have recently talked to Trish about how to code our comfort care patients and using the DC treatment box is often the case. If the patients death is not expected imminently we use the code for palliative care.It is confusing because the term palliative can mean many things. GHall 19:11, 8 May 2008 (CDT)
  • We are not coding DCtx at the Vic Medicine wards? Are we suppose to? Please let us know.SKiesman 14:51, 23 June 2008 (CDT)
    • I believe that we should all be coding the same. I personally talked to Trish about the use of the DC treatment box for patients that death was expected imminently and she agreed that palliative would not be appropriate.So as far as I know you should use the DC treatment box.GHall 13:17, 4 July 2008 (CDT)

• I removed the "ICU" from the instructions above. The first line used to say "in dying ICU patients. According to chats with Julie and I think Gail, it's not just ICU patients. Ttenbergen 23:30, 26 May 2008 (CDT)
  • I added critical care back in... Ttenbergen 11:58, 27 November 2008 (CST)