Impact of Early Do Not Resuscitate Order (DNR) on Length of Hospitalization, Intensive Care Unit Admission, and Hospital Mortality for Advanced Lung and Gastrointestinal Cancers

Ahmed Elsayem, The University of Texas School of Public Health

Abstract

Background National guidelines recommend documenting goals of care for patients with terminal conditions in their medical records within 3 days of hospitalization. However, no studies have evaluated the impact of such a measure. We examined the association of early Do Not Resuscitate (DNR) within 3 days of presentation to an emergency department (ED) on hospital length of stay, intensive care unit (ICU) admission, death in the hospital, and hospice referral. ^ Methods We searched MD Anderson patient databases for lung and gastrointestinal cancer patients who visited our ED in 2013, and had a DNR order written. Demographic information, cancer stage, ICU admissions, hospital and ICU length of stay, and hospital deaths were reviewed. Patients with early and late DNR were compared to the outcome variables of length of stay, ICU admission, hospital death, and hospice referral. ^ Results Of the 645 patients with lung and GI cancer who visited the ED and had a DNR order, 613 (95%) were admitted to the hospital. The median time to DNR order was 1 day for early DNR patient compared to 7.7 days for late DNR (p<0.001). More elderly patients had early DNR. Of all patients admitted, 164 (27%) were admitted from ED to ICU. Death in the hospital occurred in 41.5% of patients, and an equal number were discharged to hospice. Patients with early DNR had significantly shorter hospitalization compared to those with late DNR (5 vs 11; p <0.00). In a linear regression, significant factors associated with prolonged length of stay include late DNR, total ICU days, and death in the palliative care unit. In a logistic regression, factors associated with increased hospital death include total days spent in ICU, death in the palliative care unit and lung cancer, and for hospice referral the only negative association were days spent in ICU. ^ Conclusion Early DNR is associated with significantly shorter hospitalization. Days spent in ICU are strongly associated with all outcome variables. There were no differences in hospital death or hospice referral.^

Subject Area

Health care management

Recommended Citation

Elsayem, Ahmed, "Impact of Early Do Not Resuscitate Order (DNR) on Length of Hospitalization, Intensive Care Unit Admission, and Hospital Mortality for Advanced Lung and Gastrointestinal Cancers" (2015). Texas Medical Center Dissertations (via ProQuest). AAI1598367.
http://digitalcommons.library.tmc.edu/dissertations/AAI1598367

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