EMERGENCY DEPARTMENT DO-NOT-ATTEMPT-RESUSCITATION ORDERS - NEXT-OF-KIN RESPONSE TO THE EMERGENCY PHYSICIAN

Objective: To evaluate the response by families of incompetent, chroni cally debilitated, and/or terminally ill patients who were contacted f or do-not-attempt-resuscitation (DNAR) status by an emergency physicia n (EP). Methods: A prospective observational study was performed to as sess next-of-kin willingness to support DNAR status for incompetent, c hronically debilitated, and/or terminally ill patients. The families a lso were contacted by telephone follow-up 48-72 hours after the ED vis it. Upon follow-up evaluation, the families were surveyed regarding pr ior DNAR instructions and their perceptions of the establishment of DN AR status in the ED. The study was conducted in an urban teaching hosp ital with an emergency medicine residency training program. Results: O f the 71 patient families contacted, 60 (85%) of the patients had DNAR orders written in the ED. The families of these 60 patients had no ne gative response regarding contact by ED personnel. Of the 11 (15%) pat ients whose families wished no DNAR order, only two families had negat ive responses to being contacted by the EP. In both cases the families had previously given detailed instructions to the chronic care facili ty. Conclusion: The EP can play an important role in assisting the dec ision making process of families of incompetent, chronically debilitat ed, and/or terminally ill patients regarding institution of DNAR order s in the ED. Improved communication regarding existing DNAR orders wit h chronic care facilities might minimize the rare complaints received from families with preestablished DNAR orders.