'Do not resuscitate' orders. Incidence and implications in a medical-intensive care unit
S. J. Youngner, W. Lewandowski, D. K. McClish, B. W. Juknialis, C. Coulton and E. T. Bartlett
"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.
Duration of Withdrawal of Life Support in the Intensive Care Unit and Association with Family Satisfaction
Gerstel et al.
Am. J. Respir. Crit. Care Med. 2008;178:798-804.
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The do-not-resuscitate order: associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act
Morrell et al.
J. Med. Ethics 2008;34:642-647.
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Meeting Physicians' Responsibilities in Providing End-of-Life Care
Shanawani et al.
Chest 2008;133:775-786.
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Prevalence of Patients With Do-Not-Resuscitate Status on Acute Geriatric Wards in Flanders, Belgium
De Gendt et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2007;62:395-400.
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Do-Not-Resuscitate Orders in Patients Hospitalized With Acute Myocardial Infarction: The Worcester Heart Attack Study
Jackson et al.
Arch Intern Med 2004;164:776-783.
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Ethical Challenges of Partial Do-Not-Resuscitate (DNR) Orders: Placing DNR Orders in the Context of a Life-Threatening Conditions Care Plan
Berger
Arch Intern Med 2003;163:2270-2275.
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Communicating Do-Not-Resuscitate Orders With a Computer-Based System
Heffner et al.
Arch Intern Med 1998;158:1090-1095.
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The Specification of Levels of Active Intervention in a Chronic Care Hospital
Hirdes and Martin
Journal of Applied Gerontology 1993;12:125-138.
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