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Incidence, Implications, and Outcomes

Helene Levens Lipton, PhD

JAMA. 1986;256(9):1164-1169.

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.

(JAMA 1986;256:1164-1169)

Author Affiliations
From the Division of Clinical Pharmacy, School of Pharmacy, and the Institute for Health Policy Studies, School of Medicine, University of California, San Francisco.

Footnotes
Presented in part at the Gerontological Society meeting, San Francisco, Nov 17, 1983, and the Medical Care Section of the American Public Health Association meeting, Anaheim, Calif, Nov 22, 1983.

Reprint requests to Institute for Health Policy Studies, School of Medicine, University of California, 1326 Third Ave, San Francisco, CA 94143 (Dr Lipton).

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