Do-not-resuscitate orders at a chronic care hospital.

Do-not-resuscitate (DNR) orders have become an accepted part of medical practice. While these orders have been extensively evaluated in acute care hospitals, little is known about their use in the long-term care setting. We reviewed the medical records of all admissions to a chronic care hospital over a 13-month period, collecting data on selected patient characteristics, use of DNR orders, and patient outcomes during the 6-week period following admission. Fifty-eight of the 301 patients (19.3%) had a DNR order written. Patients' families were involved predominantly in the DNR decision in 73% of the cases while patients themselves were involved in only 18%. Physicians made the decision unilaterally in 6% of the cases. Patients' functional status rather than specific diagnoses predicted the use of DNR orders. Patients with DNR orders were twice as likely to receive new intravenous therapies than patients without those orders (71% vs 33%, P less than 0.01) and four times as likely to die (38% vs 9%, P less than 0.01). They were no more likely to be transferred emergently to an acute care hospital (5% vs 9%, P greater than 0.2). We conclude that DNR orders are not infrequently used, and physicians rarely make the decision unilaterally. Patients with DNR orders have a high likelihood of dying and are infrequently transferred to acute care facilities.