Do-not-resuscitate decisions in a community hospital. Incidence, implications, and outcomes

JAMA. 1986 Sep 5;256(9):1164-9.

Abstract

To investigate intensity of care after do-not-resuscitate (DNR) designation, the implications of DNR decisions were analyzed in a 450-bed community hospital. All 333 patients who received written DNR orders in a six-month period were studied. These 333 patients constituted 3% of all discharges, but 70% of patients who died in hospital. Treatment goals for care provided after DNR designation were not documented in 60% of the patients' medical records. Intensity of care, as measured by hospital charges, decreased significantly after DNR designation. Although many types of care were provided after DNR, most were noninvasive. These findings suggest that although many DNR policies consider DNR status fully compatible with aggressive care, in actual clinical practice the DNR order usually leads to less intensive care. Results further suggest that the DNR decision should properly become part of a comprehensive patient care plan individualizing treatment goals for patients.

KIE: A study was conducted to examine the intensity of care given to 333 patients in a 450-bed community hospital subsequent to their designation as do-not-resuscitate (DNR) patients. Treatment plans were not provided for 60% of the DNR patients; intensity of care, as measured by hospital charges, decreased; and type of care varied greatly, in a manner unrelated to age and not strictly consistent with prognosis. The findings suggest that clinical practice does not accord with the policy that DNR status ought to be compatible with aggressive care. The authors propose that perhaps DNR decisions should be considered as part of a general patient care plan that shifts from "therapeutic" or "aggressive" care to "supportive" or "conservative" care, ideally agreed on by patient, family, and physician.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ancillary Services, Hospital / economics
  • Ancillary Services, Hospital / statistics & numerical data
  • California
  • Costs and Cost Analysis
  • Female
  • Hospital Bed Capacity, 300 to 499
  • Hospitals, Community*
  • Humans
  • Life Support Care*
  • Male
  • Outcome and Process Assessment, Health Care
  • Patient Care Planning
  • Patient Selection*
  • Resource Allocation
  • Resuscitation* / standards
  • Withholding Treatment