title: After-hours physician care for patients with do-not-resuscitate orders: an observational cohort study.
abstract: BACKGROUND
  Medical care at night for patients with do-not-resuscitate orders and the practice patterns of the on-call residents have rarely been reported.
  
  
  OBJECTIVE
  To evaluate the after-hours physician care for patients with do-not-resuscitate orders in the general medicine ward.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  This study was conducted at an urban, university-affiliated academic medical center in Taiwan. The night shift nurses consecutively recorded every event that required calling the duty residents. Patients with and without a do-not-resuscitate order were compared in demographics, reasons for calling, residents' response, and nurses' satisfaction. A standard report form was established for the nurses to record events.
  
  
  RESULTS
  From October 2009 to September 2010, 1379 inpatients contributed to 456 after-hours calls. do-not-resuscitate patients accounted for 256 (18.7%) of all inpatients, and 160 (35.1%) of all after-hours calls. The leading reason for calls was abnormal vital signs, which was significantly higher for patients with do-not-resuscitate orders compared to patients without a do-not-resuscitate order (64.4% vs 36.1%, p < 0.001). The pattern of residents' responses showed a significant difference with more bedside visits for patients with do-not-resuscitate orders (p < 0.001). The nurses were usually satisfied with the residents' management of both groups.
  
  
  CONCLUSIONS
  Abnormal vital sign, rather than symptom, was the leading reason for after-hours calls. The existence of do-not-resuscitate order produced different medical needs and physician workload. Patients with do-not-resuscitate orders accounted for one-third of night calls and nearly half of bedside visits by on-call residents and may require a different care approach.
authors.affiliation: 1Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Nin-Chieh
authors.initials: NC
authors.lastname: Hsu
authors.forename: Ray-E
authors.initials: RE
authors.lastname: Chang
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D013624:Taiwan; D055986:Vital Signs; D016526:Workload / Q000706:statistics & numerical data
keywords: After-hours care; do not resuscitate; palliative care