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JOURNAL ARTICLE

Resource utilization and end-of-life care in a US hospital following medical emergency team-implemented do not resuscitate orders

James M Dargin, Caleb G Mackey, Yuxiu Lei, Timothy N Liesching
Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine 2014, 9 (6): 372-8
24604884

BACKGROUND: Medical emergency teams frequently implement do not resuscitate orders, but little is known about end-of-life care in this population.

OBJECTIVE: To examine resource utilization and end-of-life care following medical emergency team-implemented do not resuscitate orders.

DESIGN: Retrospective review.

SETTING: Single, tertiary care center.

PATIENTS: Consecutive adult inpatients requiring a medical emergency team activation over 1 year.

MEASUREMENTS: Changes to code status, time spent on medical emergency team activations, frequency of palliative care consultation, discharges with hospice care.

INTERVENTIONS: None.

RESULTS: We observed 1156 medical emergency team activations in 998 patients. Five percent (58/1156) resulted in do not resuscitate orders. The median time spent on activations with a change in code status was longer than activations without a change (66 vs 60 minutes, P = 0.05). Patients with a medical emergency team-implemented do not resuscitate order had a higher inpatient mortality (43 vs 27%, P = 0.04) and were less likely to be discharged with hospice at the end of life than patients with a preexisting do not resuscitate order (4 vs 29%, P = 0.01). There was no difference in palliative care consultation in patients with a preexisting do not resuscitate versus medical emergency team-implemented do not resuscitate order (20% vs 12%, P = 0.39).

CONCLUSIONS: Despite high mortality, patients with medical emergency team-implemented do not resuscitate orders had a relatively low utilization of end-of-life resources, including palliative care consultation and home hospice services. Coordinated care between medical emergency teams and inpatient palliative care services may help to improve end-of-life care.

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