Prehospital DNR orders: what do physicians in Washington know?

Area of Science:

• Medical Policy
• Emergency Medicine
• Public Health

Background:

• Washington State implemented a prehospital do-not-resuscitate (DNR) policy to guide emergency medical services (EMS).
• Physician awareness of such policies is crucial for effective implementation and patient care.

Purpose of the Study:

• To evaluate physician knowledge of Washington State's prehospital do-not-resuscitate (DNR) policy six years post-implementation.
• To identify factors associated with physician awareness of advance care planning policies.

Main Methods:

• A cross-sectional survey was conducted in Washington State in April 2001.
• Four hundred seventy-one practicing physicians participated in the survey.
• Multivariate logistic regression analyzed the relationship between physician/practice characteristics and policy knowledge.

Main Results:

• 60% of physicians were unaware that Washington State mandates a physician-authored, EMS-specific DNR order.
• 79% of physicians did not know that patient-authored advance directives are restricted to hospital and medical office settings.
• Significant gaps in knowledge regarding prehospital DNR documentation were identified.

Conclusions:

• Most physicians in Washington State lack essential knowledge regarding prehospital do-not-resuscitate (DNR) documentation requirements for EMS.
• This deficit may hinder the appropriate application of DNR orders in prehospital settings.
• Further research is needed to ascertain if physician education or legislative adjustments are required to improve compliance and understanding.