Resource use implications of do not resuscitate orders for intensive care unit patients

This study describes the use of do not resuscitate (DNR) orders for ICU patients in four northeastern U.S. teaching hospitals and investigates the relationship between DNR orders and length of stay. The use of detailed data from the mortality probability model (MPM II) study on 6,290 consecutive ICU admissions to general adult medical and surgical ICUs during 1989 through 1991 allows us to control for severity of illness and the time during the ICU stay at which the DNR order was entered. About 12.8% of patients were DNR during their ICU stay, including more than half of nonsurvivors. The percentage of patients with DNR was higher for older and more severely ill patients. Most DNR orders were issued after 72 h in the ICU, but many were issued during the first ICU day. Nonsurvivors with early (first 24 h) DNR had shorter mean and median ICU and hospital stays than the comparison group of non-DNR patients. The percentage of patients with very long ICU (> 30 d) and hospital (> 60 d) stays was smaller among DNR patients. The use of DNR orders, particularly early in the ICU stay, may be associated with significant resource use reduction for an identifiable group of patients.