title: Resuscitation orders and their relevance to patients' clinical status and outcomes.
abstract: BACKGROUND
  Documented resuscitation orders have relevance in the management of a pulseless, unresponsive patient. Although useful, the frequency of their documentation in the case notes of newly admitted medical patients is not well established.
  
  
  OBJECTIVE
  To investigate the frequency of early clear documentation of resuscitation orders in patients' admission notes.
  
  
  METHODS
  Retrospective audit.
  
  
  METHODS
  The admission notes of 618 medical admissions to an Australian tertiary referral teaching hospital between January and December 2007 were reviewed to calculate the frequency of clear resuscitation documentation. Certain outcomes of each admission, such as in-hospital death, were obtained via hospital-based computerized records.
  
  
  RESULTS
  Within the first 24 h of admission, discussions regarding resuscitation were not documented for 78% of patients. Of the 482 patients with no documented resuscitation orders, 5 patients died during their index admission. Of the 136 patients with documented resuscitation orders, 24 patients died during their index admission. As age or a measure of clinical debility increased, the absolute number and relative proportion of resuscitation discussions increased significantly (P<0.0001) and the number and proportion of patients deemed not for resuscitation also increased (P<0.0001).
  
  
  CONCLUSIONS
  Those patients apparently targeted for discussion were older, more frail and acutely unwell. We propose widespread use of a clinical scoring system to identify those patients who need their resuscitation status clarified early in their admission prior to clinical deterioration.
authors.affiliation: Department of General Medicine, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Shanmuganathan
authors.forename: J Y
authors.initials: JY
authors.lastname: Li
authors.forename: T Y
authors.initials: TY
authors.lastname: Yong
authors.forename: P H
authors.initials: PH
authors.lastname: Hakendorf
authors.forename: D I
authors.initials: DI
authors.lastname: Ben-Tovim
authors.forename: C H
authors.initials: CH
authors.lastname: Thompson
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D054869:Clinical Audit; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000592:standards; D016414:Resuscitation Orders; D012189:Retrospective Studies