title: Level of agreement on resuscitation decisions among hospital specialists and barriers to documenting do not attempt resuscitation (DNAR) orders in ward patients.
abstract: OBJECTIVE
  This study assessed the level of agreement on CPR decisions among intensive care doctors and specialist physicians and surgeons, and the barriers to documenting do not attempt resuscitation (DNAR) orders for ward patients during Medical Emergency Team (MET) calls.
  
  
  METHODS
  We prospectively assessed all patients having MET calls for 11 months. If the intensive care doctor on the MET considered a DNAR order appropriate for the patient, the primary care clinician was contacted to: (1) confirm agreement or disagreement with a DNAR order and (2) give reasons as to why a DNAR order was not considered or documented prior to the MET call.
  
  
  RESULTS
  In the study period, the MET attended 1458 patients. A DNAR order was considered appropriate in 129 cases. In 116 (90%), the primary care clinician agreed with a DNAR order at the time of the MET. Common reasons given by primary care clinicians for not documenting DNAR orders included acute or unexpected deterioration (22.5%), awaiting family discussion (22.5%), actively treating the patient for a reversible condition (17.1%), not knowing the patient well enough (10.9%) and resuscitation status not yet discussed by team (10.9%).
  
  
  CONCLUSIONS
  This study shows a high level of agreement on DNAR orders among intensive care doctors, physicians and surgeons for deteriorating ward patients. Barriers to timely documentation need to be addressed. Delay in documentation and communication of DNAR orders is common. The MET system provides an opportunity to identify patients for whom a DNAR order should be considered.
authors.affiliation: Intensive Care Unit, Liverpool Hospital, Sydney, Australia. Sharon.Micallef@sswahs.nsw.gov.au
authors.forename: Sharon
authors.initials: S
authors.lastname: Micallef
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
authors.forename: Michael J A
authors.initials: MJ
authors.lastname: Parr
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000706:statistics & numerical data; D004282:Documentation; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D016896:Treatment Outcome