Do-Not-Resuscitate Decisions in a Community Hospital
Lipton, Helene Levens
JAMA. 1986 Sep 5; 256(9): 1164-1169.
A study was conducted to examine the intensity of care given to 333 patients in a 450-bed community hospital subsequent to their designation as do-not-resuscitate (DNR) patients. Treatment plans were not provided for 60% of the DNR patients; intensity of care, as measured by hospital charges, decreased; and type of care varied greatly, in a manner unrelated to age and not strictly consistent with prognosis. The findings suggest that clinical practice does not accord with the policy that DNR status ought to be compatible with aggressive care. The authors propose that perhaps DNR decisions should be considered as part of a general patient care plan that shifts from "therapeutic" or "aggressive" care to "supportive" or "conservative" care, ideally agreed on by patient, family, and physician. (KIE abstract)
Age Factors; Costs and Benefits; Critically Ill; Decision Making; Diagnosis; Economics; Evaluation; Family Members; Hospitals; Medical Records; Mortality; Patient Care; Patients; Physicians; Prevalence; Prognosis; Records; Resource Allocation; Resuscitation; Resuscitation Orders; Selection for Treatment; Statistics; Survey; Terminal Care; Terminally Ill;
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