Factors associated with combined do-not-resuscitate and do-not-intubate orders: A retrospective chart review at an urban tertiary care center

Stream, Sara; Nolan, Anna; Kwon, Sophia; Constable, Catherine

doi:10.1016/j.resuscitation.2018.06.020

Cited by 20 publications

(12 citation statements)

References 39 publications

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“…The demographic characteristics of the participants are shown in Table 1. The median age of the ICU physician participants was 39 (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and 54.5% were female. The primary specialty of the great majority of the ICU physicians was anesthesiology (88.2%), followed by internal medicine (9.9%) and surgery (1.9%).…”

Section: Resultsmentioning

confidence: 99%

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Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey

et al. 2020

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Introduction Turkey is constitutionally secular with a Muslim majority. There is no legal basis for limiting life-support at the end-of-life (EOL) in Turkey. We aimed to investigate the opinions and attitudes of intensive care unit (ICU) physicians regarding EOL decisions, for both their patients and themselves, and to evaluate if the physicians' demographic and professional variables predicted the attitudes of physicians toward EOL decisions. Methods An online survey was distributed to national critical care societies' members. Physicians' opinions were sought concerning legalization of EOL decisions for terminally ill patients or by patient-request regardless of prognosis. Participants physicians' views on who should make EOL decisions and when they should occur were determined. Participants were also asked if they would prefer cardiopulmonary resuscitation (CPR) and/or intubation/mechanical ventilation (MV) personally if they had terminal cancer. Results A total of 613 physicians responded. Religious beliefs had no effect on the physicians' acceptance of do-not-resuscitate (DNR) / do-not-intubate (DNI) orders for terminally ill patients, but atheism, was found to be an independent predictor of approval of DNR/DNI in cases of patient request (p<0.05). While medical experience (�6 years in the ICU) was the independent predictor for the physicians' approval of DNI decisions on patient demand, the volume of terminal patients in ICUs (between 10-50% per year) where they worked was an

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Section: Resultsmentioning

confidence: 99%

“…DNI orders entered into the clinical practice at about the same time as DNR orders, and usually DNI orders are accompanied by DNR orders [33]. Code status discussions mostly bundle cardiopulmonary resuscitation with intubation in countries where EOL decisions are legal.…”

Section: Plos Onementioning

confidence: 99%

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey

et al. 2020

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“…A previous study pointed out that do-not-intubate orders were generally accompanied by DNR orders. [38] There were limitations to this study: (1) it was a retrospective study, and there were some incomplete data in the electronic medical records; (2) the relatives' satisfaction levels and emotional state regarding the quality of care in the ED could not be measured; (3) it was performed in a single academic hospital, and the results may not be representative of the general situation in the Chinese mainland.…”

Section: Discussionmentioning

confidence: 99%

Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

et al. 2020

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BACKGROUND: Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS: This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS: There were 214 patients' deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients' deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors infl uenced the family surrogates' decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confi dence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) ≥72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS: In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation.

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“…It is not surprising that resuscitation status was associated with specific patient characteristics and our study findings that age, comorbidities and functional independence influence resuscitation status resemble those of other studies. A number of studies have shown that patients with LOMT or not-for-CPR orders are more likely to be older, female and have multiple comorbidities (Jäderling et al, 2013, Jones et al, 2012a, Stream, Nolan, Kwon, & Constable, 2018. Other patient characteristics associated with LOMT or not-for-CPR orders are hospitalisation in the preceding six months (Stream et al, 2018), admission under a medical unit (Jones et al, 2012a), living in residential aged care or supported accommodation (Jones et al, 2012a) and hospital admission for an acute event (Jäderling et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Resuscitation status and characteristics and outcomes of patients transferred from subacute care to acute care hospitals: A multi‐site prospective cohort study

Street

Dunning

Bucknall

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter‐hospital transfer from a subacute to an acute care hospital. Background Patients who experience emergency inter‐hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in‐hospital mortality (15%). Design This prospective, exploratory cohort study was a subanalysis of data from a larger case–time–control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Methods Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not‐for‐cardiopulmonary resuscitation (CPR) orders) were compared using chi‐square or Kruskal–Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. Findings. Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not‐for‐CPR. Compared to patients for full resuscitation, patients with not‐for‐CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not‐for‐CPR were less likely to be readmitted to acute care and more likely to return to subacute care. Conclusions Two‐thirds of patients in subacute care who experienced an emergency inter‐hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not‐for‐CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients. Relevance to Clinical Practice As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.

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Factors associated with combined do-not-resuscitate and do-not-intubate orders: A retrospective chart review at an urban tertiary care center

Cited by 20 publications

References 39 publications

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey

Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

Resuscitation status and characteristics and outcomes of patients transferred from subacute care to acute care hospitals: A multi‐site prospective cohort study

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