RESOURCE USE IMPLICATIONS OF DO NOT RESUSCITATE ORDERS FOR INTENSIVE-CARE UNIT PATIENTS

This study describes the use of do not resuscitate (DNR) orders for IC U patients in four northeastern U.S. teaching hospitals and investigat es the relationship between DNR orders and length of stay. The use of detailed data from the mortality probability model (MPM II) study on 6 ,290 consecutive ICU admissions to general adult medical and surgical ICUs during 1989 through 1991 allows us to control for severity of ill ness and the time during the ICU stay at which the DNR order was enter ed. About 12.8% of patients were DNR during their ICU stay, including more than half of nonsurvivors. The percentage of patients with DNR wa s higher for older and more severely ill patients. Most DNR orders wer e issued after 72 h in the ICU, but many were issued during the first ICU day. Nonsurvivors with early (first 24 h) DNR had shorter mean and median ICU and hospital stays than the comparison group of non-DNR pa tients. The percentage of patients with very long ICU (> 30 d) and hos pital (> 60 d) stays was smaller among DNR patients. The use of DNR or ders, particularly early in the ICU stay, may be associated with signi ficant resource use reduction for an identifiable group of patients.