title: Do-not-resuscitate decisions in a large tertiary hospital: differences between wards and results of a hospital-wide intervention.
abstract: BACKGROUND
  Despite the advent of palliative care, the quality of dying in the hospital remains poor. Differences in quality of end-of-life practice between hospital wards are well known in clinical practice but rarely have been investigated.
  
  
  METHODS
  A prospective observation of do-not-resuscitate (DNR) decisions was conducted in patients dying in a Belgian university hospital before (115 patients) and after (113 patients) a hospital-wide intervention consisting in informing hospital staff on the law on Patient's Rights and the introduction of a new DNR form.The new DNR form puts more emphasis on the motivation of the DNR decision and on the description of the participants in the decision-making process.
  
  
  RESULTS
  The completion of DNR forms improved after the intervention: physicians better documented who participated in DNR decisions (for participation of family: 63% after the intervention vs. 44% before the intervention, p = 0.022, for nurses: 27% vs. 14%, p = 0.047) and the motivation for these decisions (59% vs. 32%, p = 0.001). However, there was no difference in referral to the intensive care unit (ICU) at the end of life (in 40% of patients after and 37% before the intervention). Furthermore, the number of patients dying without DNR form on the wards was similar (13% and 8%). Surgical patients and patients with non-malignant diseases were more often referred to ICU at the end of life (71% in surgical vs. 35% in medical patients, p < 0.001 and 49% in patients with non-malignant diseases vs. 23% in patients with malignancy, p < 0.001). Moreover, surgical patients less frequently received a DNR order (56% in surgical vs. 92% in medical patients, p = 0.007).
  
  
  CONCLUSIONS
  The introduction of a new DNR form and informing hospital staff on patients' right to information did not improve physicians' end-of-life practice.Transition from life-prolonging treatment to a more palliative approach was less anticipated in surgical patients and patients with non-malignant diseases.
authors.affiliation: Department of Geriatrics, Ghent University Hospital, Ghent, Belgium. ruth.piers@ugent.be
authors.forename: R D
authors.initials: RD
authors.lastname: Piers
authors.forename: D D
authors.initials: DD
authors.lastname: Benoit
authors.forename: W J
authors.initials: WJ
authors.lastname: Schrauwen
authors.forename: N J
authors.initials: NJ
authors.lastname: Van Den Noortgate
mesh_terms: D001291:Attitude of Health Personnel; D016638:Critical Illness / Q000523:psychology / Q000628:therapy; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008020:Life Support Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D010166:Palliative Care / Q000941:ethics / Q000523:psychology; D010564:Personnel, Hospital / Q000941:ethics / Q000523:psychology; D011050:Policy Making; D012151:Resuscitation / Q000941:ethics / Q000523:psychology; D016414:Resuscitation Orders / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D012297:Right to Die / Q000941:ethics / Q000331:legislation & jurisprudence