Out-of-hospital do-not-resuscitate orders by primary care physicians. J Emerg Med 2002 Nov;23(4):425-8
Date
12/14/2002Pubmed ID
12480032DOI
10.1016/s0736-4679(02)00586-3Scopus ID
2-s2.0-0036860380 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
The objective of this study was to determine the knowledge, utilization, and experience of primary care physicians (PCPs) with nonhospital do-not-resuscitate (NH-DNR) orders. An anonymous survey was sent to all PCPs in a single northeastern county. Up to two surveys were mailed to each PCP. Descriptive statistics were used to report provider responses. The main variable of interest was issuance of NH-DNR orders. Surveys were mailed to 820 PCPs; 348 (42%) were returned. Respondents had practiced an average 17 +/- 11 years, and cared for an average of 720 patients per month, 7 of whom were terminally ill. Seventy percent issued NH-DNR orders. Twenty-five percent reported resuscitation had been attempted for at least one patient with a NH-DNR order; 64% reported this had happened more than once. Of respondents who had a NH-DNR order ignored, 14% had instructed family members to call police, fire, or EMS following death of the patient. Of the PCPs who did not issue NH-DNR orders, 71% reported not caring for any appropriate patients, yet 41% reported caring for at least 1 terminally ill patient per month. Seventy-nine percent disagreed that intubation and mechanical ventilation were appropriate treatment for DNR patients in severe respiratory distress, and 71% disagreed that cardioversion was appropriate treatment for an unconscious DNR patient with unstable ventricular tachycardia. In conclusion, a majority of respondents issued NH-DNR orders and one quarter reported these orders had not been followed. A majority felt intubation, mechanical ventilation, and cardioversion should not be performed for noncardiac arrest DNR patients with an indication, but not in cardiac arrest.
Author List
Lerner EB, Billittier AJ, Hallinan KMESH terms used to index this publication - Major topics in bold
AdultAttitude of Health Personnel
Clinical Competence
Emergency Medical Services
Family Practice
Health Care Surveys
Humans
Physicians, Family
Practice Patterns, Physicians'
Quality of Health Care
Resuscitation Orders
Risk Assessment
United States
Withholding Treatment
