title: Impact of do-not-resuscitate legislation on the use of cardiopulmonary resuscitation in three teaching hospitals.
abstract: Under New York State's unique do-not-resuscitate law, patients admitted to a hospital are assumed to consent to cardiopulmonary resuscitation unless a do-not-resuscitate order has been written in accordance with specific stipulations. This study was undertaken to determine if the law would significantly change the use of cardiopulmonary resuscitation. The charts of 952 patients who died on the medical services of Bellevue, New York University, and New York Veterans hospitals during the 12-month periods before and after the law went into effect were reviewed. The proportion of patients undergoing cardiopulmonary resuscitation was determined. To take into account the effects of potential confounders (ie, hospital, sex, race or ethnic group, age, diagnosis), a multiple logistic regression analysis was performed. The relative risk for cardiopulmonary resuscitation was found to be 0.81, (95% confidence interval: 0.59-1.10) after the law as compared with before, which was not statistically significant. Although patients with chronic or potentially reversible illness were much more likely than those with hopeless illness to undergo cardiopulmonary resuscitation (relative risk of 7.08 [3.23-15.54] and 12.89 [8.71-19.07], respectively), the data failed to show that the law had an impact on the use of cardiopulmonary resuscitation in any of the disease categories. Total use of formal do-not-resuscitate orders increased from 32.7% to 83.9% (p less than .0001), although at Bellevue, where documentation was high before the law, no further increase occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, New York University School of Medicine-Bellevue, New York University Tisch Hospital, NY.
authors.forename: J C
authors.initials: JC
authors.lastname: Ahronheim
authors.forename: S
authors.initials: S
authors.lastname: Maheswaran
authors.forename: C
authors.initials: C
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006323:Heart Arrest / Q000401:mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D012151:Resuscitation / Q000706:statistics & numerical data*; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies