Do-not-resuscitate decisions in a community hospital: implications for quality care

The appropriateness of medical care provided to patients after DNR designation was analyzed in a 450-bed community hospital. All 333 patients who received written DNR orders in a six-month period were studied. Appropriateness of care was assessed by three physician consultants, each of whom independently reviewed a case abstract prepared for every patient. In 95% of the cases, care after DNR designation was judged appropriate relative to the patient's diagnosis and prognosis. Care was judged inadequate in 1 case and overly aggressive in 17 cases. These findings suggest that the DNR decision does not lead to medical abandonment of the patient and that the expensive and invasive medical care resources are not being allocated inappropriately in the vast majority of DNR patients.