The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit |
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| Authors: | Rubin I Cohen Gita N Lisker Ann Eichorn Alan S Multz Alan Silver |
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| Institution: | 1. The Division of Pulmonary, Critical Care and Sleep Medicine, The Long Island Jewish Medical Center, The Albert Einstein College of Medicine, New Hyde Park, NY, USA;2. The Krasnoff Quality Management Institute, North Shore-Long Island Jewish Health System, Great Neck, NY, USA |
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| Abstract: | PurposeTo determine whether the presence of a do-not-resuscitate (DNR) order impacts on triage decisions to a medical intensive care unit (MICU) of an academic medical center.MethodsData were collected on 179 patients in whom MICU consultation was sought and included demographic, clinical information, diagnoses, ICU admission decision, Acute Physiological and Chronic Health Evaluation II (APACHE II) score, and the presence of DNR order. Functional status was determined retrospectively using the Modified Rankin Score.ResultsThe only factor that influenced MICU admission was the presence of DNR order at the time of MICU consultation (odds ratio, 0.25; 95% confidence interval, 0.09-0.71, P < .006). There was no difference between the age, APACHE II scores, or functional status between admitted or refused. Medical intensive care unit admission was associated with increased length of stay without difference in mortality.ConclusionThe presence of a DNR order at the time of MICU consultation was significantly associated with the decision to refuse a patient to the MICU. |
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| Keywords: | Do-not-resuscitate order Triage decisions Medical intensive care unit |
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