Emergency department do-not-attempt-resuscitation orders: next-of-kin response to the emergency physician

To evaluate the response by families of incompetent, chronically debilitated, and/or terminally ill patients who were contacted for do-not-attempt-resuscitation (DNAR) status by an emergency physician (EP).

A prospective observational study was performed to assess next-of-kin willingness to support DNAR status for incompetent, chronically debilitated, and/or terminally ill patients. The families also were contacted by telephone follow-up 48-72 hours after the ED visit. Upon follow-up evaluation, the families were surveyed regarding prior DNAR instructions and their perceptions of the establishment of DNAR status in the ED. The study was conducted in an urban teaching hospital with an emergency medicine residency training program.

Of the 71 patient families contacted, 60 (85%) of the patients had DNAR orders written in the ED. The families of these 60 patients had no negative response regarding contact by ED personnel. Of the 11 (15%) patients whose families wished no DNAR order, only two families had negative responses to being contacted by the EP. In both cases the families had previously given detailed instructions to the chronic care facility.

The EP can play an important role in assisting the decision making process of families of incompetent, chronically debilitated, and/or terminally ill patients regarding institution of DNAR orders in the ED. Improved communication regarding existing DNAR orders with chronic care facilities might minimize the rare complaints received from families with preestablished DNAR orders.