scholarly journals DNR Code Status Is Not Associated with Under-Utilization of Inpatient Transthoracic Echocardiograms

2021 ◽  
Vol 8 (9) ◽  
pp. 112
Author(s):  
Adarsh Katamreddy ◽  
Aaron J. Wengrofsky ◽  
Weijia Li ◽  
Cynthia C. Taub
Keyword(s):  
Transthoracic Echocardiography ◽  
Multivariate Model ◽  
Do Not Resuscitate ◽  
Univariate Logistic Regression Analysis ◽  
Medical Interventions ◽  
Code Status ◽  
Final Multivariate Model ◽  
Patient Admissions ◽  
Retrospective Data Analysis ◽  
Final Study

In the strictest sense, do-not-resuscitate (DNR) status means that cardiopulmonary resuscitation should not be performed after death has occurred; all other medical interventions in line with a patient’s goals of care should be implemented. The use of transthoracic echocardiography (TTE) in patients with DNR status is unknown. Therefore, we aim to evaluate the utilization of TTE among patients with DNR status using this retrospective data analysis. A total of 16,546 patient admissions were included in the final study. A total of 4370 (26.4%) of the patients had a TTE during hospitalization; among full code patients, 3976 (25.7%) underwent TTE, whereas TTEs were performed in 394 (37.4%) of DNR patients. On univariate logistic regression analysis, full code status had OR (95% confidence interval, CI) 0.57 (0.51–0.66), p < 0.01 compared with DNR status for the performance of inpatient TTE. In the final multivariate model adjusted for age, sex, race, and clinical comorbidities, the full code patients had OR (95% CI) 0.91 (0.79–1.05), p = 0.22 compared with DNR patients for the performance of inpatient TTE. DNR status is not associated with a decrease in inpatient transthoracic echocardiography performance.

A Month in an Acute Palliative Care Unit

2011 ◽  
Vol 28 (8) ◽  
pp. 550-555 ◽  
Author(s):  
Ahmed Elsayem ◽  
Bianca B. Calderon ◽  
Eden M. Camarines ◽  
Gabriel Lopez ◽  
Eduardo Bruera ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Do Not Resuscitate ◽  
Advanced Cancer Patients ◽  
Financial Outcomes ◽  
Clinical Interventions ◽  
Medical Interventions ◽  
Code Status ◽  
Palliative Care Consultation ◽  
Consultation Team

Background: Few cancer centers have developed acute palliative care units (APCUs). The purpose of this study is to highlight clinical interventions and financial outcomes during a typical 1-month period on an APCU. Methods: We evaluated consecutive patients admitted to our APCU from February 1 to 28, 2009, regarding demographic information, sources of and reasons for admissions, resuscitation status, clinical interventions, disposition, and reimbursement data. Results: Forty-two patients were admitted during a 1-month period. Of these, 30 (71%) were referred from the inpatient palliative care consultation team. In all, 10 (24%) patients had a full code status on admission, and 8 had their status changed to do not resuscitate (DNR) prior to discharge. A total of 11 (26%) patients were discharged home with hospice care, 12 (29%) died on the APCU, and 10 (24%) were discharged home with outpatient follow-up visits. All patients received intravenous medications and the majority received intravenous antibiotics. All patients met acute care criteria for hospitalization, and financial reimbursement was satisfactory and comparable to that of other oncology patients. Conclusion: The APCU model is designed for the care of very complex advanced cancer patients. Palliative interventions are given simultaneously with other medical interventions. The APCU is labor intensive and well reimbursed.

Association of medical futility with do-not-resuscitate (DNR) code status in hospitalised patients

2021 ◽  
pp. medethics-2020-106977
Author(s):  
Christoph Becker ◽  
Alessandra Manzelli ◽  
Alexander Marti ◽  
Hasret Cam ◽  
Katharina Beck ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Medical Futility ◽  
University Hospital ◽  
Main Diagnosis ◽  
Do Not Resuscitate ◽  
Clinical Frailty Scale ◽  
Code Status ◽  
Probability Of Survival ◽  
Hospitalised Patients ◽  
Definition Of

Guidelines recommend a ‘do-not-resuscitate’ (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Good Outcome Following Attempted Resuscitation score and the Clinical Frailty Scale in patients hospitalised in the Divisions of Internal Medicine and Traumatology/Orthopedics at the University Hospital of Basel between September 2018 and June 2019. The definition of presumed CPR futility was met in 467 (16.2%) of 2889 patients. 866 (30.0%) patients had a DNR code status. In a regression model adjusted for age, gender, main diagnosis, nationality, language and religion, presumed CPR futility was associated with a higher likelihood of a DNR code status (37.3% vs 7.1%, adjusted OR 2.99, 95% CI 2.31 to 3.88, p<0.001). In the subgroup of patients with presumed futile CPR, 144 of 467 (30.8%) had a full code status, which was independently associated with younger age, male gender, non-Christian religion and non-Swiss citizenship. We found a significant proportion of hospitalised patients to have a full code status despite the fact that CPR had to be considered futile according to an established definition. Whether these decisions were based on patient preferences or whether there was a lack of patient involvement in decision-making needs further investigation.

scholarly journals Prevalence of skin tears in hospitalized adults and older adults

2021 ◽  
Vol 55 ◽  
Author(s):  
Luccas Melo de Souza ◽  
Gabriela da Silva Teixeira ◽  
Débora Monteiro da Silva ◽  
Letícia da Silva Ruiz ◽  
Isabella dos Santos Coppola ◽  
...  
Keyword(s):  
Older Adults ◽  
Medical Records ◽  
Care Setting ◽  
Prevalence Ratio ◽  
Multivariate Model ◽  
Bivariate Analysis ◽  
Related Factors ◽  
Final Multivariate Model ◽  
Robust Variance ◽  
Skin Tears

ABSTRACT Objective: To identify the prevalence, related factors and to classify Skin Tears in hospitalized adults and older adults. Method: Prevalence study with adults and older adults in inpatient and intensive care units of a hospital in the South Region of Brazil. The STAR Skin Tear Classification System was used to analyze the lesions. Data were collected by physical examination and consultation of medical records. The Poisson Regression Prevalence Ratio with robust variance was calculated. Results: The participants were 148 patients. There were 29 Skin Tears (mean 1.6 ± 0.7) in 18 individuals (prevalence of 12.2%). The variables age, friable skin, enteral feeding catheter, degree of dependence, use of antihypertensives, micronutrients, diuretics, antidepressants, and antifungals were associated with lesions in the bivariate analysis. In the final multivariate model, antihypertensives PR 2.42 (95%CI 1.01-5.77), antidepressants PR 2.72 (95%CI 1.1-6.33) and micronutrients PR 4.93 (95%CI 1.64-14.80) maintained a relationship. Conclusion: The prevalence of injuries was 12.2%, showing they are present in the health care setting, especially in nursing care. Care protocols need to be developed for the prevention, identification and early treatment of ST.

scholarly journals A cross-sectional study among healthcare and non-healthcare students in slovenia and croatia about do-not resuscitate decision-making

2019 ◽  
Vol 58 (3) ◽  
pp. 139-147
Author(s):  
Jure PUC ◽  
Petra Obadić ◽  
Vanja Erčulj ◽  
Ana Borovečki ◽  
Štefan Grosek
Keyword(s):  
University Students ◽  
Cross Sectional Study ◽  
Do Not Resuscitate ◽  
Best Interest ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Respect For Autonomy ◽  
Final Study ◽  
Case Vignettes ◽  
The University

Abstract Objective To survey university students on their views concerning the respect for autonomy of patients and the best interest of patients in relation to the withholding of resuscitation. Methods A cross-sectional survey among university students of medicine, nursing, philosophy, law and theology of the first and the final study years at the University of Ljubljana and the University of Zagreb was conducted during the academic year of 2016/2017. A questionnaire constructed by Janiver et al. presenting clinical case vignettes was used. Results The survey response rates for students in Ljubljana and Zagreb were 45.4% (512 students) and 37.9% (812 students), respectively. The results of our research show statistically significant differences in do-not resuscitate decisions in different cases between medical and non-medical students in both countries. Male and religious students in both countries have lower odds of respecting relatives’ wishes for the withholding of resuscitation (odds ratio 0.49–0.54; 95% confidence interval). All students agreed that they would first resuscitate children if they had to prioritize among patients. Conclusions Our study clearly shows that gender, religious beliefs, and type of study are important factors associated with the decisions pertaining to the respect for autonomy, patient’s best interest, and initiation or withholding of resuscitation.

scholarly journals Investigating the Impact of Indemnity Waivers on the Length of Stay of Cats at an Australian Shelter

Animals ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 50 ◽  
Author(s):  
Jessica Pockett ◽  
Bronwyn Orr ◽  
Evelyn Hall ◽  
Wye Li Chong ◽  
Mark Westman
Keyword(s):  
Length Of Stay ◽  
Coat Colour ◽  
Multivariate Model ◽  
Australian Capital Territory ◽  
Animal Shelters ◽  
Resource Limitations ◽  
Final Multivariate Model ◽  
Likelihood Model ◽  
Cruelty To Animals ◽  
The Impact

Due to resource limitations, animal shelters in Australia historically have focused on rehoming animals considered ‘highly adoptable’. Increasingly, animal shelters in Australia are rehoming animals with pre-existing medical and/or behavioural issues. These animals are often rehomed with an ‘indemnity waiver’ to transfer the responsibility of ongoing financial costs associated with these conditions from the shelter to the new owner. However, it is unknown what effect these indemnity waivers have on the length of stay (LOS) of animals prior to adoption. The current study used data collected from the Royal Society for the Prevention of Cruelty to Animals (RSPCA) Weston shelter located in the Australian Capital Territory (ACT), Australia in 2017 to investigate the effect of indemnity waivers on the LOS of cats. A restricted maximum likelihood model (REML) was used to determine the effect of breed, age, coat colour, presence of a waiver, waiver type (categorised into seven groups) and waiver number (no waiver, single waiver or multiple waivers) on LOS. In the final multivariate model, age, breed and waiver number were found to influence LOS. Young cats, purebred cats and cats adopted without a waiver were adopted fastest. This study is the first to report the effect of indemnity waivers on the adoptability of cats from shelters.

Clinician Perspectives on Challenges to Patient Centered Care at the End of Life

2016 ◽  
Vol 36 (4) ◽  
pp. 401-415 ◽  
Author(s):  
Shoshana H. Bardach ◽  
Edward J. Dunn ◽  
J. Christopher Stein
Keyword(s):  
End Of Life ◽  
Medical Center ◽  
Local Policy ◽  
Do Not Resuscitate ◽  
Patient Centered ◽  
Code Status ◽  
Respiratory Therapists ◽  
Centered Care ◽  
Preventive Ethics ◽  
Dnr Orders

Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients’ end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients’ preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients’ end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

Suicide and “do not resuscitate”: An ethical dilemma

2020 ◽  
pp. 147775092095955
Author(s):  
Muhammad Tariq Shakoor ◽  
Abdul Ahad ◽  
Samia Ayub ◽  
James Kruer
Keyword(s):  
Advance Directives ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Living Will ◽  
Living Wills ◽  
Do Not Resuscitate ◽  
End Of Life Decisions ◽  
Medical Interventions ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Advance directives allow people to accept or decline medical interventions and to appoint surrogate decision makers if they become incapacitated. Living wills are written in ambiguous terms and require interpretation by clinical providers. Living wills cannot cover all conceivable end-of-life decisions. There is too much variability in clinical decision making to make an all-encompassing living will possible. While there are many limitations of advance directives, this article reviews some of the most troublesome ethical dilemmas with regard to advance directives.

scholarly journals L’utilisation des échelles de niveaux d’interventions médicales en centre hospitalier

2016 ◽  
Vol 35 (1) ◽  
pp. 70-78
Author(s):  
Marjolaine Frenette ◽  
Jocelyne Saint-Arnaud
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Treatment Options ◽  
Medical Intervention ◽  
Treatment Withdrawal ◽  
Decision Making Process ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Levels Of Care

ABSTRACTDifferent care settings in Quebec use levels of medical intervention forms, also called levels of care (LOC), to determine the code status of patients and to improve end-of-life care planning. It is not currently possible to know whether the levels of care in hospitals benefit patients and staff in facilitating the decision making process of treatment options and resuscitation measures. No study, to the best of the authors’ knowledge, has been published about LOC, particularly in Quebec and Canada. This literature review was undertaken on levels of care in order to clarify this topic. Relevant articles are discussed under different themes that are pertinent to LOC. The themes addressed in this article include care at the end of life, do-not-resuscitate orders, treatment withdrawal, and decision making at end of life.

Are “Allow Natural Death” orders preferable to “Do Not Resuscitate” orders for patients with advanced cancer?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20685-e20685
Author(s):  
Dennis Omoding Emuron ◽  
Milos Miljkovic ◽  
Lori Rhodes ◽  
Joseph Abraham ◽  
Kenneth David Miller
Keyword(s):  
Advanced Cancer ◽  
Cancer Education ◽  
Living Will ◽  
Small Sample ◽  
Do Not Resuscitate ◽  
Natural Death ◽  
P Values ◽  
Feeding Tubes ◽  
Code Status ◽  
Eol Care

e20685 Background: Over twenty years after the passage of the Patient Self-Determination Act, patients’ preferences regarding end-of-life (EOL) care are often unknown to physicians. The aim of this study was to assess the knowledge and attitudes of cancer patients regarding EOL care, and to compare “Do Not Resuscitate” (DNR) and “Allow Natural Death” (AND) orders. Methods: Adult patients with advanced cancer were invited to participate. The first 50 consenting patients were surveyed regarding their prognosis and attitudes about critical care and resuscitation. We presented them with hypothetical scenarios in which a decision on their code status had to be made if they had 1 year, 6 months or 1 month left to live. Twenty-five patients were given a choice between being “full code" and DNR, and then 25 patients had a choice between "full code" and AND. Results: Almost half the patients (49%) were not aware that their illness was terminal. Fifty percent reported having a living will. However, only 19% reported that their doctors knew their wishes regarding EOL care. In contrast, greater than 78% reported knowledge of intubation, tracheotomy, feeding tubes, and cardiopulmonary resuscitation (CPR). The proportions of participants choosing full resuscitation compared to the DNR or AND options did not differ significantly from 50% (p-values > 0.54). Their choices did not vary by age, sex, race, type of cancer, education or income level (p-values > 0.05). Patients' attitudes towards CPR, tracheostomy and feeding tubes were not significantly associated with their choice of "DNR" (p-values > 0.17), but those who wanted these interventions were significantly less likely to choose "AND" (p-values < 0.002). As many as 38% of the patients without a living will chose "DNR", while 11% opted for "AND" (p-values < 0.03). Conclusions: In this small sample of patients with advanced cancer many were unaware of their poor prognosis, and few informed their physicians of their EOL preferences. The wording of DNR and AND orders was not associated with patients' EOL preferences. Contrary to our expectation, the "Allow Natural Death" phrasing might be less acceptable to patients who view life-prolonging measures favorably.

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