title: Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an Intensive Care Unit.
abstract: Admission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p < 0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead; p = 0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility. Conclusions. Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status.
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, FL 33140, USA.
authors.forename: Debjit
authors.initials: D
authors.lastname: Saha
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, FL 33140, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, FL 33140, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Csete
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, FL 33140, USA.
authors.forename: Elizabeth Kury
authors.initials: EK
authors.lastname: Perez
authors.affiliation: Health Professions Division, Nova Southeastern University, Miami Beach, FL 33140, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cubeddu
authors.affiliation: Mount Sinai Medical Center, Intensive Care Units, Miami Beach, FL 33140, USA.
authors.forename: David
authors.initials: D
authors.lastname: Farcy
authors.affiliation: Information Technology Group, Mount Sinai Medical Center, Miami Beach, FL 33140, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Henry
authors.affiliation: Information Technology Group, Mount Sinai Medical Center, Miami Beach, FL 33140, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Glazer
authors.affiliation: Louisiana State University Health Sciences Center New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Moreno-Walton
authors.affiliation: Mount Sinai Medical Center, Department of Internal Medicine, Miami Beach, FL 33140, USA.
authors.forename: Robert C
authors.identifier: 0000-0001-5326-1827
authors.initials: RC
authors.lastname: Goldszer