Do-not-resuscitate decisions in a community hospital. Incidence, implications, and outcomes

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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. All these 333 patients constituted 3% of all discharges, but 70% of patients died in hospital. Treatment goals for care provided after DNA designation were not documented in 60% of the patients'' medical records. Intensity of care, as measured by hospital charges, decreased significantly after DNA designation. Although many types of care were provided after DNA, 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.