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Communicating do-not-resuscitate orders with a computer-based system

J E Heffner¹, C Barbieri, P Fracica

¹Department of Medicine, St Joseph's Hospital and Medical Center, Phoenix, Ariz 85001, USA. jheffner@mha.chw.edu

Archives of Internal Medicine

|May 30, 1998

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A computer system improves do-not-resuscitate (DNR) order communication for critically ill patients. This system enhances understanding among physicians and nurses, leading to better patient care coordination.

Area of Science:

Medical Informatics
Critical Care Medicine
Patient Communication

Background:

Communication of do-not-resuscitate (DNR) orders is often flawed among healthcare providers for critically ill patients.
A procedure-specific DNR order form was developed to address these communication gaps.

Purpose of the Study:

To evaluate the effectiveness of a computer-based system in improving the communication and understanding of do-not-resuscitate (DNR) orders.

Main Methods:

A study measured the concordance of understanding of patients' DNR status across three periods: unstructured orders, procedure-specific forms, and computer-assisted procedure-specific forms.
Key components assessed included the clinical events, scope of resuscitation withheld, and other treatments affected by the DNR order.

Keywords:

Death and Euthanasia Empirical Approach St. Joseph's Hospital and Medical Center (Phoenix, AZ)

Related Experiment Videos

Main Results:

The computer-based system significantly improved concordance of DNR order understanding among attending physicians, house staff, and nurses.
Agreement on all three DNR components increased substantially, with overall agreement rising from 22.2% to 61.9% over the study periods.
The system also facilitated the detection and correction of 9.9% of order entry errors.

Conclusions:

A computer-based system, when used with a procedure-specific DNR order form, demonstrably enhances communication of DNR status in critical care settings.
This improved communication leads to better shared understanding and potentially safer patient care regarding resuscitation preferences.