Daniel J. Pallin, MD, MPH reviewing McQuown CM et al. Am J Emerg Med 2017 Feb 3.

A small study finds poor emergency department and hospital documentation of do-not-resuscitate status, despite its being documented at the transferring facility.

Clinicians are ethically obligated to make a reasonable attempt to ascertain and then respect patients' wishes regarding their healthcare, including do-not-resuscitate (DNR) orders. In Ohio, state law requires that DNR orders be transported with patients transferred from one facility to another. In a study of 50 patients (mean age, 78 years) transferred from extended care facilities to an academic emergency department (ED) in Ohio, investigators determined status of DNR orders at the originating facility and in the ED or hospital after patient arrival.

DNR orders were on file at the originating facility for 68% of patients, but only 28% had DNR orders transported to the ED. An advance directive was noted by registration staff for 32% of patients, and by the ED physician for 18%. A DNR order was written by the ED physician for 16% of patients and by another physician during the hospital stay for 28%.

CITATION(S):

McQuown CM et al. Transfer of do not resuscitate orders to the emergency department from extended care facilities. Am J Emerg Med 2017 Feb 3; [e-pub]. 

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