The need for a do-not-resuscitate policy in a public city hospital

Abstract

Data were collected over a six-month period from in-hospital cardiopulmonary resuscitation (CPR) patients (aged 18 years and older) who were admitted to a public hospital. The sample population was mostly male (55.4 percent), primarily black (90.6 percent), with a mean age of 61 years. Medical expenses for these patients were largely covered by public funds or medical charities, reflecting the predominately low socioeconomic status of the population. The proportion of patients discharged alive after in-hospital CPR was 6.1 percent. The CPR sample contains a large proportion of patients in the terminal phase of diseases such as metastatic cancer, acquired immune deficiency syndrome (AIDS), and end-stage liver disease. Chart reviews revealed that do-not-resuscitate (DNR) orders were not presented as a therapeutic option to either patient or family in the majority of instances. These findings indicate a need to develop standards and strategies for decision making about the use of CPR specific to this population.