Perceptions of care following initiation of do-not-resuscitate orders

Purpose: Documenting do-not-resuscitate (DNR) status in the surgical intensive care unit (ICU) can be controversial; some providers believe that DNR orders change care. This survey evaluates current perceptions. Materials and methods: IRB approved survey consisting of 31 validated questions divided into 3 factors (1. palliation, 2. active treatment, and 3. trust/communication). Individual questions were compared using Fisher's exact-tests and factors were compared via t-tests. Results: Both surgical and ICU staff believe care decreases after DNR order initiation (43%). More surgical staff report decreased care aggressiveness versus ICU staff (63% vs 25%, p < 0.005 and Factor 2, 25.8 versus 29.8, p < 0.001), and felt that electrical cardioversion outside of the setting of ACLS would not be performed (57% vs 24%, p < 0.005). Conclusions: Surgical staff expressed more concern about care after DNR status than their ICU counterparts. Determining whether care actually changes clinically warrants further investigation. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This article investigates the perceptions of surgical and ICU staff regarding the impact of DNR orders on care. The results show that surgical staff express more concern about decreased care after DNR status compared to ICU staff. Further investigation is needed to determine whether there are actual clinical changes.