Physicians' do-not-resuscitate decisions and documentation in a community hospital

Physician documentation of the participants in do-not-resuscitate (DNR) decisions and the equitability of DNR decisions were studied in a 450-bed community hospital in San Francisco. All 333 patients who received written DNR orders and the 108 physicians who made DNR decisions were studied. Of the sampled records, 45% contained no documentation of who participated in the DNR decision. Only 38% of the documented records showed that patients were involved in the DNR decision. In the remaining cases (62%), families were involved as surrogate decision makers. The rate of physicians' DNR decision-making varied according to physician specialty: Oncologists, neurologists, gastroenterologists, and pulmonologists had the highest rates, while surgeons, cardiologists, and general practitioners had the lowest.