The do-not-resuscitate order in teaching hospitals.

Area of Science:

• Medical Ethics
• Clinical Practice
• Healthcare Management

Background:

• Do-not-resuscitate (DNR) orders aim to align end-of-life care with patient wishes and facilitate timely decision-making.
• Teaching hospitals without official DNR protocols may present challenges in consistent application and goal achievement.

Purpose of the Study:

• To evaluate the utilization of DNR orders in three teaching hospitals lacking formal protocols.
• To assess whether current DNR practices align with established goals of promoting patient autonomy and pre-crisis decision-making.

Main Methods:

• Retrospective analysis of patient records and decision-making processes related to DNR orders.
• Inclusion of data from three teaching hospitals without pre-existing official DNR protocols.

Main Results:

• Approximately 20% of patients had or were considered for DNR orders.
• Patient/family involvement was high (83%) in DNR decisions but low (25%) in decisions to resuscitate or cases with no decision.
• Varied care was provided to DNR patients, with some receiving partial resuscitation efforts.

Conclusions:

• Current DNR order practices in these institutions are not fully achieving their intended goals.
• Significant discrepancies exist in patient/family involvement between DNR decisions and resuscitation decisions.
• Six proposals are suggested to enhance future DNR protocols and improve alignment with patient autonomy and timely decision-making.