• J Hosp Med · Jun 2014

    Resource utilization and end-of-life care in a US hospital following medical emergency team-implemented do not resuscitate orders.

    • James M Dargin, Caleb G Mackey, Yuxiu Lei, and Timothy N Liesching.
    • Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts.
    • J Hosp Med. 2014 Jun 1; 9 (6): 372-8.

    BackgroundMedical emergency teams frequently implement do not resuscitate orders, but little is known about end-of-life care in this population.ObjectiveTo examine resource utilization and end-of-life care following medical emergency team-implemented do not resuscitate orders.DesignRetrospective review.SettingSingle, tertiary care center.PatientsConsecutive adult inpatients requiring a medical emergency team activation over 1 year.MeasurementsChanges to code status, time spent on medical emergency team activations, frequency of palliative care consultation, discharges with hospice care.InterventionsNone.ResultsWe 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).ConclusionsDespite 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.© 2014 Society of Hospital Medicine.

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