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DNR or CPR--the choice is ours.

S G Stern1, J P Orlowski

  • 1Pediatric and Surgical Intensive Care Unit, Cleveland Clinic Foundation, OH 44195-5086.

Critical Care Medicine
|September 1, 1992
PubMed
Summary
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Implementing do-not-resuscitate (DNR) policies significantly reduced terminal resuscitative efforts and increased patient-centered care for critically ill patients. This shift improved comfort and dignity in end-of-life care.

Area of Science:

  • Critical Care Medicine
  • Medical Ethics
  • Health Policy

Background:

  • Terminal care for critically ill patients has historically involved aggressive resuscitative efforts.
  • The implementation of specific policies aims to improve end-of-life care, focusing on patient wishes and dignity.

Purpose of the Study:

  • To evaluate the impact of implementing do-not-resuscitate (DNR) order policies and hopelessly ill patient care guidelines.
  • To assess changes in terminal care practices for critically ill patients before and after policy implementation.

Main Methods:

  • Retrospective chart review of patients who died in a surgical ICU.
  • Comparison of three groups: pre-DNR policy (1981-1982), immediately pre-DNR policy (June-December 1987), and post-DNR policy (1988).
Keywords:
Cleveland Clinic FoundationDeath and EuthanasiaEmpirical Approach

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Main Results:

  • No significant differences in patient demographics or ICU length of stay were observed between groups.
  • A significant decrease in terminal resuscitative efforts (52% to 3%) and a significant increase in DNR order application (46% to 98%) were noted.
  • The ability to withdraw support increased significantly (23% to 73%) post-policy implementation.

Conclusions:

  • The institution of DNR policies was associated with a significant shift in end-of-life care philosophy.
  • ICUs can successfully identify hopelessly ill patients and implement care reflecting medical prognostication and patient/family wishes.
  • Policies improved patient comfort and dignity during terminal care.