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


CONCLUSIONS
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.
Cohen
Rubin I
RI
The Division of Pulmonary, Critical Care and Sleep Medicine, The Long Island Jewish Medical Center, The Albert Einstein College of Medicine, New Hyde Park, NY 11044, USA. rcohen@lij.edu
Lisker
Gita N
GN
Eichorn
Ann
A
Multz
Alan S
AS
Silver
Alan
A