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Certain hospital characteristics influence the use of early do-not-resuscitate (DNR) orders, according to a new study. An early DNR order was defined as one written within 24 hours of admission. The odds of having an early DNR order were significantly less at large, for-profit, academic hospitals than at small, private nonprofit, nonacademic hospitals.


The study involved 819,686 patients age 50 and older admitted to 386 acute care hospitals in California in 2000. Early DNR orders varied from 2% in patients ages 50 to 59 years to 17% in patients 80 years and older.


Researchers examined the study cases to see if certain hospital characteristics influenced the timing of DNR orders. They found that the highest rates of early DNR use involved patients from rural areas. County population, hospital bed availability, and population density didn't affect use of early DNR orders. Findings held true even after accounting for differences in patient characteristics.


The researchers found that the use of early DNR orders appears to be associated with hospital culture, technological bent, and physician practice patterns. "If these factors do not match patient preferences," they concluded, "then improvements in care are needed."




Regional and institutional variation in the initiation of early do-not-resuscitate orders, Archives of Internal Medicine, DS Zingmond, NS Wenger, August 22, 2005.