The Impact of Do-Not-Resuscitate Order in the Emergency Department on Respiratory Failure after ICU Admission

Healthcare

Yuan-Jhen Syue¹  Po-Chun Chuang²  Ting-Yu Hsu²  Tsung-Cheng Tsai²  Chao-Jui Li²  Yan-Ren Lin³  Pei-Ming Wang⁴ 

[1] Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua City 500, Taiwan;Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;

关键词: emergency department;    do-not-resuscitate;    respiratory failure;    intensive care unit;    medical fee;   

DOI  :  10.3390/healthcare10030434

来源: DOAJ

【 摘 要 】

(1) Background: It has been hypothesized that a discrepancy exists in the understanding of a do-not-resuscitate (DNR) order among physicians. We hypothesized that a DNR order signed in the emergency department (ED) could influence the patients’ prognosis after intensive care unit (ICU) admission. (2) Methods: We included patients older than 17 years, who visited the emergency department for non-traumatic disease, who had respiratory failure, required ventilator support, and were admitted to the ICU between January 2010 and December 2016. The associations between DNR and mortality, hospital length of stay (LOS), and medical fees were analyzed. Prolonged hospital LOS was defined as hospital stay ≥75th percentile (≥26 days for the study). Patients were classified as those who did and did not sign a DNR order. A 1:4 propensity score matching was conducted for demographics, comorbidities, and etiology. (3) Results: The study enrolled a total of 1510 patients who signed a DNR and 6040 patients who did not sign a DNR. The 30-day mortality rates were 47.4% and 28.0% among patients who did and did not sign a DNR, respectively. A DNR order was associated with mortality after adjusting for confounding factors (hazard ratio, 1.9; confidence interval, 1.70–2.03). It was also a risk factor for prolonged hospital LOS in survivors (odds ratio, 1.2; confidence interval, 1.02–1.44). Survivors who signed a DNR order were charged higher medical fees than those who did not sign a DNR (217,159 vs. 245,795 New Taiwan Dollars, p < 0.001). (4) Conclusions: Signing a DNR order in the ED increased the ICU mortality rate among patients who had respiratory failure and needed ventilator support. It increased the risk of prolonged hospital LOS among survivors. Finally, signing a DNR order was associated with high medical fees among survivors.

【 授权许可】

Unknown