Resource utilization and end-of-life care in a US hospital following medical emergency team-implemented do not resuscitate orders.
J Hosp Med
; 9(6): 372-8, 2014 Jun.
Article
en En
| MEDLINE
| ID: mdl-24604884
ABSTRACT
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Grupo de Atención al Paciente
/
Cuidado Terminal
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Órdenes de Resucitación
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Servicios Médicos de Urgencia
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Centros de Atención Terciaria
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Recursos en Salud
Tipo de estudio:
Observational_studies
Aspecto:
Ethics
Límite:
Aged
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Aged80
/
Female
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Humans
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Male
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Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Hosp Med
Año:
2014
Tipo del documento:
Article