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Do‐Not‐Resuscitate Orders at a Chronic Care Hospital
Author(s) -
Berlowitz Dan R.,
Wilking Spencer V. B.,
Moskowitz Mark A.
Publication year - 1991
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1991.tb02492.x
Subject(s) - medicine , do not resuscitate , do not resuscitate order , resuscitation orders , medical record , medical diagnosis , acute care , emergency medicine , pediatrics , intensive care medicine , cardiopulmonary resuscitation , health care , resuscitation , pathology , economics , economic growth
Do‐not‐resuscitate (DNR) orders have become an accepted part of medical practice. While these orders have been extensively evaluated in acute care hospitals, little is known about their use in the long‐term care setting. We reviewed the medical records of all admissions to a chronic care hospital over a 13‐month period, collecting data on selected patient characteristics, use of DNR orders, and patient outcomes during the 6‐week period following admission. Fifty‐eight of the 301 patients (19.3%) had a DNR order written. Patients' families were involved predominantly in the DNR decision in 73% of the cases while patients themselves were involved in only 18%. Physicians made the decision unilaterally in 6% of the cases. Patients' functional status rather than specific diagnoses predicted the use of DNR orders. Patients with DNR orders were twice as likely to receive new intravenous therapies than patients without those orders (71% vs 33%, P < 0.01) and four times as likely to die (38% vs 9%, P < 0.01). They were no more likely to be transferred emergently to an acute care hospital (5% vs 9%, P > 0.2). We conclude that DNR orders are not infrequently used, and physicians rarely make the decision unilaterally. Patients with DNR orders have a high likelihood of dying and are infrequently transferred to acute care facilities.