The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit

• Published in: Journal of critical care Vol. 24; no. 2; pp. 311 - 315
• Main Authors: Cohen, Rubin I., MD, Lisker, Gita N., MD, Eichorn, Ann, MS, Multz, Alan S., MD, Silver, Alan, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2009; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; APACHE; Bias; Cognitive ability; Critical Care; Disability; Do-not-resuscitate order; Female; Hospital Mortality; Humans; Illnesses; Intensive care; Intensive Care Units - organization & administration; Length of Stay; Male; Medical intensive care unit; Middle Aged; Older people; Physicians; Respiration, Artificial; Resuscitation Orders; Risk Factors; Socioeconomic Factors; Teaching hospitals; Triage - organization & administration; Triage decisions; Variables; Triage decisions; Medical intensive care unit; Do-not-resuscitate order
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2008.01.007

Abstract Purpose To determine whether the presence of a do-not-resuscitate (DNR) order impacts on triage decisions to a medical intensive care unit (MICU) of an academic medical center. Methods Data were collected on 179 patients in whom MICU consultation was sought and included demographic, clinical information, diagnoses, ICU admission decision, Acute Physiological and Chronic Health Evaluation II (APACHE II) score, and the presence of DNR order. Functional status was determined retrospectively using the Modified Rankin Score. Results The only factor that influenced MICU admission was the presence of DNR order at the time of MICU consultation (odds ratio, 0.25; 95% confidence interval, 0.09-0.71, P < .006). There was no difference between the age, APACHE II scores, or functional status between admitted or refused. Medical intensive care unit admission was associated with increased length of stay without difference in mortality. Conclusion The presence of a DNR order at the time of MICU consultation was significantly associated with the decision to refuse a patient to the MICU.