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CPR or DNR? End-of-life decision making on a family practice teaching ward
Objective:
To determine the proportion of patients on a family practice ward who had "code status" orders and end-of-life discussions documented on their charts in the first week of admission. To examine the correlation between a tool predicting the likelihood of benefit from cardiopulmonary resuscitation (CPR) and actual end-of-life decisions made by family physicians and their patients.
Design:
Cross-sectional descriptive study using a retrospective chart review.
Setting:
A 14-bed teaching ward where family physicians admit and manage their own patients in an urban tertiary care teaching hospital.
Participants:
Patients admitted to the ward for 7 or more days between December 1, 1995, and August 31, 1996.
Main Outcome Measures:
Frequency of documented "do not resuscitate" (DNR) or "full code" orders and documented end-of-life discussions. Prognosis-after-resuscitation (PAR) score.
Results:
In the 103 charts reviewed, code status orders were entered within 7 days for 60 patients (58%); 31 were DNR, and 29 were full code. Discussion of code status was documented in 25% of charts. The PAR score for 40% of patients was higher than 5, indicating they were unlikely to survive to discharge from hospital should they require CPR. There was a significant association between PAR scores done retrospectively and actual code status decisions made by attending family physicians (P < .005).
Conclusions:
End-of-life discussions and decisions were not fully documented in patients' charts, even though patients were being cared for in hospital by their family physicians. A PAR score obtained during the first week of admission could assist physicians in discussing end-of-life orders with their patients.