Management of the patient with do not resuscitate status: compassion and cost containment

An interdisciplinary approach to the management of patients with do not resuscitate status on a supportive care team is an alternative to traditional intensive care unit management. This approach focuses on the physical, psychological, and spiritual needs of the patient and family. We describe our experience with 131 patients managed by the supportive care team that resulted in humane care of dying patients and reduced hospital costs as evidenced by reduced Therapeutic Intervention Scoring System values. Although our goal is comprehensive terminal care, financial savings have resulted as well. We describe the elements of care that contribute to compassionate management and to reduced interventions and costs. This approach may have application in other critical care settings that are faced with the same challenges of providing humane care to hopelessly ill patients.