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The choice not to be resuscitated.

D A Schwartz, P Reilly

    Journal of the American Geriatrics Society
    |November 1, 1986
    PubMed
    Summary
    This summary is machine-generated.

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    The do not resuscitate (DNR) order was used in 3.9% of general medical admissions. DNR patients had higher mortality, but the decision was based on prognosis and influenced care allocation.

    Area of Science:

    • Medical Ethics
    • Clinical Practice
    • Patient Care

    Background:

    • Do not resuscitate (DNR) orders are crucial in end-of-life care decisions for general medical patients.
    • Understanding the utilization and impact of DNR orders is essential for improving patient outcomes and resource allocation.

    Purpose of the Study:

    • To investigate the patterns of DNR order use in general medical patients.
    • To analyze the characteristics of patients with DNR orders and their impact on medical care and resource utilization.

    Main Methods:

    • Retrospective study of 2431 general medical admissions over six months.
    • Analysis of patient demographics, clinical characteristics, DNR order initiation, and impact on nonresuscitative care.
    • Comparison of DNR patients with age- and sex-matched control subjects.
    Keywords:
    Boston City HospitalDeath and EuthanasiaEmpirical Approach

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    Main Results:

    • 95 patients (3.9%) had DNR orders; 66% of deaths occurred in this group.
    • Medical interns initiated discussions in 90% of cases, with decisions often made within 24 hours.
    • DNR patients had longer hospitalizations, were more likely to reside in nursing homes, and had higher rates of metastatic neoplasm, abnormal mental status, and urinary incontinence.
    • DNR orders impacted nonresuscitative care in one-third of cases, primarily through less aggressive therapy.

    Conclusions:

    • DNR decisions are informed by clinical prognostic factors.
    • DNR orders significantly influence the allocation of medical resources and patient care.
    • Despite high mortality, DNR patients were not disproportionately admitted to the ICU.