This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (6)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • End-of-life Care/ Palliative Medicine  • Quality of Care, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Daniel P. Sulmasy, OFM, MD, PhD; Johanna R. Sood, MA; Wayne A. Ury, MD

Arch Intern Med. 2004;164:1573-1578.

Background  Care plans for patients with do-not-resuscitate (DNR) orders often fail to define limits other than cardiopulmonary resuscitation and fail to address other patient care needs. We studied the explicitness and comprehensiveness of care plans for patients with DNR orders and what factors were associated with this aspect of the quality of their care.

Methods  A cross-sectional study was conducted at Georgetown University Medical Center (GUMC), Washington, DC, and St Vincent Catholic Medical Centers (SVCMC), St Vincent's Hospital–Manhattan, New York, NY. Participants included 189 consecutive medical inpatients with DNR orders.

Results  A previously validated medical chart review technique termed concurrent care concerns (CCCs) measured whether 11 possible patient care needs had been addressed within 2 days of the DNR order. Reasons for the DNR order were documented in only 55% of cases, and a consent conversation was documented in only 69%. The mean number of total CCCs per DNR order was 1.55 (1.84 at GUMC and 1.29 at SVCMC; (P = .007). In a multivariate logistic regression analysis of low (1) vs high (2) CCCs, patients with malignancy (P = .002), higher APACHE III (Acute Physiology and Chronic Health Evaluation III) scores (P = .007), and a documented consent conversation (P = .009) and those at Georgetown (P = .005) were more likely to have high attention to CCCs. Patients with dementia were the least likely to have high attention to CCCs.

Conclusions  Documented consent conversations and care plans for patients with DNR orders are less than ideal. Care plans differ in quality by diagnosis, institution, and whether or not a consent conversation is documented. These observations might help to guide interventions that aim to improve the care of patients with DNR orders.

From the John J. Conley Department of Ethics (Drs Sulmasy and Ury and Ms Sood), and the Section of Palliative Care, Department of Medicine (Dr Ury), St Vincent's Hospital–Manhattan, New York, NY; and the Bioethics Institute of New York Medical College, Valhalla, NY (Drs Sulmasy and Ury). The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Advance Directives and Resuscitation Issues in the Care of Patients in Orthopaedic Surgery
Mannino et al.
JBJS 2008;90:2037-2042.
FULL TEXT  

Withholding care in intracerebral hemorrhage: Realistic compassion or self-fulfilling prophecy?
Rabinstein and Diringer
Neurology 2007;68:1647-1648.
FULL TEXT  

Early care limitations independently predict mortality after intracerebral hemorrhage
Zahuranec et al.
Neurology 2007;68:1651-1657.
ABSTRACT | FULL TEXT