 |
|
The Quality of MercyCaring for Patients With 'Do Not Resuscitate' Orders
Daniel P. Sulmasy, OFM, MD;
Gail Geller, ScD;
Ruth Faden, PhD, MPH;
David M. Levine, MD, MPH, ScD
JAMA. 1992;267(5):682-686.
Abstract
| |
Objective.
—To assess (1) the effect of an ethics education intervention for medical house officers on practices surrounding "Do Not Resuscitate" (DNR) orders and (2) the association of DNR care with patient diagnosis and demographic variables.
Design.
—A 1-year randomized, controlled trial.
Setting.
—An urban, university teaching hospital.
Participants.
—Eighty-eight internal medicine house officers.
Intervention.
—House officers were arbitrarily assigned to four "firms." One firm was randomized to an extensive ethics education intervention (EI), one to a limited intervention, and two served as controls.
Main Outcome Measures.
—Charts of patients with DNR orders were reviewed for compliance with the hospital's DNR policy, which instructs that when DNR orders are written there should be (1) an attending signature, (2) documentation of reasons, (3) appropriate consent, and (4) attention to 11 concurrent care concerns (CCCs) (eg, the appropriateness of intubation, tube feedings, hospice).
Results.
—Thirty-nine charts were reviewed before the intervention and 57 after. The number of CCCs per DNR order fell among patients cared for by controls (1.9 to 1.0, P<.05) and rose among patients cared for by the El group (0.9 to 3.8, P<.05). Compliance with the DNR policy varied among patients with differing diagnoses. "Do Not Resuscitate" orders were signed less frequently (P=.01) for patients with the acquired immunodeficiency syndrome (AIDS) (65%) compared with patients who had other diagnoses (85%) or malignancy (91%). Similarly, appropriate consent was recorded for 59% of patients with AIDS, 83% of others, and 85% of those with malignancy (P<.05). The number of CCCs per DNR was 0.7 for AIDS, 1.4 for others, and 2.4 for malignancy (P<.05). In multivariate regression analysis, house officer ethics education and patient diagnosis, but not patient gender, age, race, or insurance status, were predictors of the number of CCCs per DNR.
Conclusions.
—(1) An extensive ethics education intervention can improve care for DNR patients, especially with respect to CCCs. (2) In this setting, quality of care for DNR patients varied systematically with diagnosis. These results have implications for the design and implementation of ethics education programs.
(JAMA. 1992;267:682-686)
Author Affiliations
From the Division of Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine (DrsSulmasy and Levine), and The Center for Law, Ethics, and Health, Department of Health Policy and Management, The Johns Hopkins University School of Hygiene and Public Health (Drs Geller and Faden), Baltimore, Md. Dr Sulmasy is currently with The Center for Clinical Bioethics and the Department of Medicine, Georgetown University School of Medicine, Washington, DC.
Footnotes
Reprint requests to Center for Clinical Bioethics, 311 Kober-Cogan Hall, Georgetown University Medical Center, Washington, DC 20007 (Dr Sulmasy).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Early care limitations independently predict mortality after intracerebral hemorrhage
Zahuranec et al.
Neurology 2007;68:1651-1657.
ABSTRACT
| FULL TEXT
The Quality of Care Plans for Patients With Do-Not-Resuscitate Orders
Sulmasy et al.
Arch Intern Med 2004;164:1573-1578.
ABSTRACT
| FULL TEXT
Impact of a Proactive Approach to Improve End-of-Life Care in a Medical ICU
Campbell and Guzman
Chest 2003;123:266-271.
ABSTRACT
| FULL TEXT
Evaluation of do not resuscitate orders (DNR) in a Swiss community hospital
Junod Perron et al.
J. Med. Ethics 2002;28:364-367.
ABSTRACT
| FULL TEXT
A Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life
Sulmasy
Gerontologist 2002;42:24-33.
ABSTRACT
| FULL TEXT
Quality Indicators for End-of-Life Care in Vulnerable Elders
Wenger and Rosenfeld
ANN INTERN MED 2001;135:677-685.
FULL TEXT
Education of Physicians-in-Training Can Decrease the Risk for Vascular Catheter Infection
Sherertz et al.
ANN INTERN MED 2000;132:641-648.
ABSTRACT
| FULL TEXT
Changing Physician Performance: A Systematic Review of the Effect of Continuing Medical Education Strategies
Davis et al.
JAMA 1995;274:700-705.
ABSTRACT
Terminal Care of the Very Old: Changes in the Way We Die
Hesse
Arch Intern Med 1995;155:1513-1518.
ABSTRACT
Evaluation of a Treatment Limitation Policy With a Specific Treatment-Limiting Order Page
O'Toole et al.
Arch Intern Med 1994;154:425-432.
ABSTRACT
The Quality of Mercy Is Not Strained
Finder
JAMA 1992;268:471-471.
ABSTRACT
The Quality of Mercy Is Not Strained-Reply
Sulmasy et al.
JAMA 1992;268:471-472.
ABSTRACT
|
