title: Resource utilization and end-of-life care in a US hospital following medical emergency team-implemented do not resuscitate orders.
abstract: BACKGROUND
  Medical emergency teams frequently implement do not resuscitate orders, but little is known about end-of-life care in this population.
  
  
  OBJECTIVE
  To examine resource utilization and end-of-life care following medical emergency team-implemented do not resuscitate orders.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Single, tertiary care center.
  
  
  METHODS
  Consecutive adult inpatients requiring a medical emergency team activation over 1 year.
  
  
  METHODS
  Changes to code status, time spent on medical emergency team activations, frequency of palliative care consultation, discharges with hospice care.
  
  
  METHODS
  None.
  
  
  RESULTS
  We observed 1156 medical emergency team activations in 998 patients. Five percent (58/1156) resulted in do not resuscitate orders. The median time spent on activations with a change in code status was longer than activations without a change (66 vs 60 minutes, P = 0.05). Patients with a medical emergency team-implemented do not resuscitate order had a higher inpatient mortality (43 vs 27%, P = 0.04) and were less likely to be discharged with hospice at the end of life than patients with a preexisting do not resuscitate order (4 vs 29%, P = 0.01). There was no difference in palliative care consultation in patients with a preexisting do not resuscitate versus medical emergency team-implemented do not resuscitate order (20% vs 12%, P = 0.39).
  
  
  CONCLUSIONS
  Despite high mortality, patients with medical emergency team-implemented do not resuscitate orders had a relatively low utilization of end-of-life resources, including palliative care consultation and home hospice services. Coordinated care between medical emergency teams and inpatient palliative care services may help to improve end-of-life care.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: James M
authors.initials: JM
authors.lastname: Dargin
authors.forename: Caleb G
authors.initials: CG
authors.lastname: Mackey
authors.forename: Yuxiu
authors.initials: Y
authors.lastname: Lei
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Liesching
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000639:trends*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000639:trends*; D062606:Tertiary Care Centers / Q000639:trends*; D014481:United States