Do-not-resuscitate orders in a county hospital

The use of the do-not-resuscitate order has become accepted medical practice. To date, however, no study has been done of how often it is used or factors associated with its use. Reports of all deaths of inpatients occurring during calendar year 1981 at San Bernardino County Medical Center were eligible for study. Retrospective review of the 237 cases indicated that a do-not-resuscitate order had been written for 165 (69.6%) of the patients. Comparison of reports of those for whom such an order had been written with those for whom no order had been written indicated that a do-not-resuscitate order was not associated with age, sex, ethnicity or pay status. Indices of mental clarity, however, were associated with orders not to resuscitate; those patients residing in nursing homes, and not alert and oriented on admission were overrepresented in the group given this order. Primary discharge diagnosis was also associated with such an order, as was an increased duration of hospital stay.