Factors associated with two different protocols of do-not-resuscitate orders in a medical ICU
Journal
Critical Care Medicine
Journal Volume
42
Journal Issue
10
Pages
2188-2196
Date Issued
2014
Author(s)
Abstract
Objective: The State of Ohio in the United States has the legislation for two different protocols of do-not-resuscitate orders. The objective of this study was to examine the clinical/demographic factors and outcomes associated with the two different do-notresuscitate orders.Design: Data were concurrently and retrospectively collected from August 2002 to December 2005. The clinical/demographic factors of do-not-resuscitate patients were compared with those of non-do-not-resuscitate patients, and the clinical/demographic factors of do-not-resuscitate comfort care-arrest patients were compared with those of do-not-resuscitate comfort care patients. Setting: An ICU in a university-affiliated hospital located at Northeast Ohio in the United States. Patients: A sample of 2,440 patients was collected: 389 patients were do-not-resuscitate; and 2,051 patients were non-do-notresuscitate. Among the 389 do-not-resuscitate patients, 194 were do-not-resuscitate comfort care-arrest patients and 91 were do-not-resuscitate comfort care patients. Interventions: None. Measurements and Main Results: The factors associated with donot-resuscitate were older age, race and ethnicity with white race, more severe clinical illness at admission to the ICU, and longer stay before admission to the ICU. Comparing do-not-resuscitate comfort care-arrest patients with do-not-resuscitate comfort care patients, those with more severe clinical illness, longer ICU stay before making a do-not-resuscitate decision, and being cared for by only one intensivist during ICU stay were significantly associated with do-not-resuscitate comfort care decisions. For 149 do-not-resuscitate patients who eventually survived to hospital discharge and 86 do-not-resuscitate patients who eventually did not, only eight (5.4%) and 23 (26.7%) had the order written within 48 hours before the end of ICU stay, respectively. Conclusions: Our study showed that some clinical/demographic factors predicted do-not-resuscitate comfort care orders. This study also suggested that Ohio's Do-Not-Resuscitate Law, clearly indicating two different protocols of do-not-resuscitate orders, facilitated early do-not-resuscitate decision. ? 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Other Subjects
adult; aged; Article; Caucasian; clinical protocol; disease severity; do not resuscitate; ethnic difference; female; hospital admission; hospital discharge; human; intensive care unit; intensivist; length of stay; major clinical study; male; outcome assessment; patient care; patient comfort; retrospective study; survival rate; United States; age; ancestry group; clinical protocol; epidemiology; middle aged; resuscitation; statistics and numerical data; treatment outcome; university hospital; Age Factors; Aged; Clinical Protocols; Continental Population Groups; Female; Hospitals, University; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Ohio; Outcome and Process Assessment (Health Care); Resuscitation Orders; Retrospective Studies
Publisher
Lippincott Williams and Wilkins
Type
journal article