Do-not-resuscitate orders, unintended consequences, and the ripple effect.
Do-not-resuscitate (DNR) orders are commonly implemented in the critical care setting as a prelude to end-of-life care. This is often based on presumed prognosis for favorable outcome and interpretation of patient, family, and even physician wishes. While DNR orders explicitly apply only to an individual patient, the hospital culture and milieu in which DNR orders are implemented could potentially have an overall impact on aggressiveness of care across patients. As illustrated by the example of intracerebral hemorrhage, this may unexpectedly influence outcome even in patients without DNR orders in place.
Hemphill
J Claude
JC
Department of Neurology, Room 4M62, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA. chemphill@sfgh.ucsf.edu
D002543:Cerebral Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016017:Odds Ratio; D010166:Palliative Care; D011379:Prognosis; D016414:Resuscitation Orders; D015996:Survival Rate; D013727:Terminal Care / Q000706:statistics & numerical data; D014481:United States