title: Transfer of DNR orders to the ED from extended care facilities.
abstract: OBJECTIVE
  With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay.
  
  
  METHODS
  We prospectively enrolled patients presenting from ECFs to the ED, blinding the treating team to the purpose. We did a chart review for the presence of a DNR form, demographic data and acknowledgement of the DNR forms.
  
  
  RESULTS
  Fifty patients were enrolled in this study. The mean age was 77.6years and 56% were female. Twenty-eight percent had a DNR order transported to the ED, but 68% had a DNR preference noted in their ECF notes. Registration only noted an advanced directive on 32% of patients (p=0.09). Eighteen percent had a DNR noted by the ED physician (p=0.42). Sixteen percent of patients had a DNR order written by an ED physician while 28% had a DNR order written by a non-ED physician during their inpatient evaluation. Thirty percent had a palliative care consult while in the hospital, but there was no significant association between DNR from the ECF and these consults.
  
  
  CONCLUSIONS
  Hospital staff did a poor job of noting DNR preferences and ECFs were inconsistent with sending Ohio DNR forms.
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, 525 East Market St, Akron, OH 44304, United States; Northeast Ohio Medical University, 4209 Ohio 44, Rootstown, OH 44272, United States. Electronic address: mcmcquown@yahoo.com.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McQuown
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, 525 East Market St, Akron, OH 44304, United States. Electronic address: freyja@summahealth.org.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Frey
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, 525 East Market St, Akron, OH 44304, United States; 4M Emergency Systems, 5700 Darrow Rd. Ste. 106, Hudson, OH 44236, United States. Electronic address: ahmadamireh928@gmail.com.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Amireh
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, 525 East Market St, Akron, OH 44304, United States; Reading Hospital, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States. Electronic address: alichaud@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Chaudhary
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital; D005260:Female; D005568:Forms and Records Control / Q000458:organization & administration* / Q000592:standards; D006299:Health Services for the Aged; D006801:Humans; D007902:Length of Stay; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D009820:Ohio; D017063:Outcome Assessment, Health Care; D010344:Patient Advocacy; D010820:Physicians; D011446:Prospective Studies; D016414:Resuscitation Orders; D012866:Skilled Nursing Facilities
keywords: Do-not-resuscitate; EMS; Extended care facilities