Epidemiology of no-code orders in an academic hospital

Relatively little is known about the circumstances in which decisions not to resuscitate, documented by no-code orders, are made. By review of medical records and interviews with house staff officers, we studied all medical service patients for whom no-code orders were written and those patients who received cardiopulmonary resuscitation (CPR) between October and December 1980 in the Portland Veterans Administration Medical Center. Among 1,780 patients admitted, 56 (3.1%) received no-code orders. All decisions were reportedly made by groups of individuals usually including the intern (98% of cases) and resident (93%), but not attending physician (39%). Many patients (43%) were disoriented or obtunded at the time of the no-code decision and 80% of oriented patients did participate in the decision.Thirty-seven of the 56 no-code patients died during the study. Comparing these with 20 patients who experienced cardiac arrest and did receive CPR, cancer, dementia, incontinence, non-ambulatory, divorced-separated and unemployed statuses were all more prevalent among no-code patients (P<.05).No-code orders in this Veterans Administration teaching hospital were relatively common and appeared to be made collectively. Participation of patients and attending physicians in the decisions, however, was limited.