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Do-not-resuscitate orders in a county hospital
The Western Journal of Medicine
|January 1, 1984
Summary
Do-not-resuscitate (DNR) orders are common in hospitals, used in 69.6% of patient deaths. Factors like mental clarity and longer hospital stays influenced DNR order use.
Area of Science:
- Medical Practice
- Clinical Ethics
- Healthcare Management
Background:
- Do-not-resuscitate (DNR) orders are established medical practice.
- Limited research exists on the frequency and influencing factors of DNR orders.
- Understanding DNR utilization is crucial for patient care and hospital policy.
Purpose of the Study:
- To determine the frequency of DNR order use in a hospital setting.
- To identify patient characteristics and clinical factors associated with DNR order placement.
- To provide data for improving end-of-life care discussions and documentation.
Main Methods:
- Retrospective review of inpatient deaths at San Bernardino County Medical Center during 1981.
- Analysis of 237 patient death records.
- Comparison of demographic, clinical, and hospital stay data between patients with and without DNR orders.
Main Results:
- A DNR order was present in 165 (69.6%) of 237 studied deaths.
- DNR orders were not significantly associated with patient age, sex, ethnicity, or pay status.
- Factors associated with DNR orders included impaired mental clarity (nursing home residence, not alert/oriented), primary diagnosis, and extended hospital stay.
Conclusions:
- DNR orders are frequently utilized in inpatient settings.
- Patient's cognitive status and clinical condition, rather than demographics, are key factors in DNR order decisions.
- Further research should explore the nuances of end-of-life decision-making and the impact of DNR orders on patient outcomes.