Impact of the DNR therapeutic plan on patient care requirements

BACKGROUND. The intensity and nature of a patient therapeutic plan should depend upon the specific therapeutic goals. When the therapeutic plan includes a do-not-resuscitate order, the intensity of the plan may be high or low. OBJECTIVE. To examine the differences in patient care requirements and hospital outcomes in patients with a do-not-resuscitate status to determine the most appropriate care setting, eg, intensive vs nonintensive care. METHOD. Data from a prospective sample of 100 patients were analyzed. Patients were grouped according to the intensity of the therapeutic plan: (1) all-but-CPR: all support except cardiopulmonary resuscitation, (2) conservative-care: medical management without the addition of life-sustaining measures, (3) comfort-only, and (4) withdrawal of life-sustaining therapy. RESULTS. Patient mortality was high for all groups except the conservative-care group. Patient care requirements remained high in the all-but-CPR group, necessitating continued intensive care. Patient care requirements decreased significantly in the comfort-only and withdrawal groups, illustrating the ability to manage these patients in a nonintensive care setting.

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