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Incidence and Implications in a Medical Intensive Care Unit

Stuart J. Youngner, MD; Wendy Lewandowski, RN, BSN; Donna K. McClish, PhD; Barbara W. Juknialis, MA; Claudia Coulton, PhD; Edward T. Bartlett, PhD

JAMA. 1985;253(1):54-57.

Abstract
"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.

(JAMA 1985;253:54-57)

Author Affiliations
From the Departments of Psychiatry (Dr Youngner), Medicine (Drs Youngner and McClish), and Biometry (Dr McClish), the Center for the Critically III (Drs Youngner and McClish and Mss Lewandowski and Juknialis), and the School of Applied Social Sciences (Dr Coulton), University Hospitals of Cleveland and Case Western Reserve University School of Medicine, Cleveland; and the Department of Philosophy, Cleveland State University (Dr Bartlett).

Footnotes
Reprint requests to Department of Psychiatry, University Hospitals of Cleveland, 2040 Abington Rd, Cleveland, OH 44106 (Dr Youngner).

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