"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.
Youngner SJ, Lewandowski W, McClish DK, Juknialis BW, Coulton C, Bartlett ET. 'Do Not Resuscitate' OrdersIncidence and Implications in a Medical Intensive Care Unit. JAMA. 1985;253(1):54–57. doi:10.1001/jama.1985.03350250062023