Quality of resuscitation orders in general medical patients

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dc.contributor.authorMcNeill, D.
dc.contributor.authorMohapatra, B.
dc.contributor.authorLi, J.
dc.contributor.authorSpriggs, D.
dc.contributor.authorAhamed, S.
dc.contributor.authorGaddi, Y.
dc.contributor.authorHakendorf, P.
dc.contributor.authorBen-Tovim, D.
dc.contributor.authorThompson, C.
dc.date.issued2012
dc.description.abstractBackground: Documentation of resuscitation status in hospitalized patients has relevance in the management of cardiopulmonary arrest. Its association with mortality, Length Of hospital Stay (LOS) and the patients’ primary diagnosis has not been established in general medical inpatients in hospitals in Australia and New Zealand. Aim: To investigate the association of resuscitation orders with in-hospital mortality and LOS in a range of diagnoses, adjusting for severity of illness and other covariates. Design: Retrospective study. Methods: The admission notes of 1681 medical admissions to four tertiary care teaching hospitals across Australia and New Zealand were reviewed retrospectively for frequency and nature of resuscitation documentation and its association with mortality, LOS and primary diagnosis. Results: Resuscitation orders were documented in 741 patients (44.7%). For the 232 patients with a Not For Resuscitation (NFR) order, the in-hospital mortality rate was higher than in control patients (14% vs. 1.2%, P < 0.005). The mortality rate remained significantly higher in the NFR group after propensity matching of the controls for age and co-morbidity (14% vs. 5%, P < 0.005). The death-adjusted LOS for the NFR group was also significantly higher compared to the control patients (9.7 days vs. 4.7 days, P < 0.005) and this difference remained after propensity matching (9.7 days vs. 7.7 days, P < 0.05). Those patients with a primary diagnosis of respiratory tract infection or cardiac failure were more likely to be documented NFR compared to those with cellulitis or urinary tract infection. Conclusions: The documentation of NFR in a patient's admission notes is associated with increased in-hospital mortality and LOS. This is only partly explicable in terms of these patients’ greater age and co-morbidity.
dc.description.statementofresponsibilityD. McNeill, B. Mohapatra, J.Y.Z. Li, D. Spriggs, S. Ahamed, Y. Gaddi, P. Hakendorf, D.I. Ben-Tovim and C.H. Thompson
dc.identifier.citationQJM: an international journal of medicine, 2012; 105(1):63-68
dc.identifier.doi10.1093/qjmed/hcr137
dc.identifier.issn1460-2725
dc.identifier.issn1460-2393
dc.identifier.orcidThompson, C. [0000-0002-5164-3327]
dc.identifier.urihttp://hdl.handle.net/2440/70760
dc.language.isoen
dc.publisherOxford Univ Press
dc.rights© The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
dc.source.urihttps://doi.org/10.1093/qjmed/hcr137
dc.subjectHumans
dc.subjectRespiratory Tract Infections
dc.subjectCellulitis
dc.subjectUrinary Tract Infections
dc.subjectResuscitation Orders
dc.subjectHospitalization
dc.subjectMedical Records
dc.subjectHospital Mortality
dc.subjectCase-Control Studies
dc.subjectRetrospective Studies
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectQuality of Health Care
dc.subjectAustralia
dc.subjectNew Zealand
dc.subjectHeart Failure
dc.subjectYoung Adult
dc.titleQuality of resuscitation orders in general medical patients
dc.typeJournal article
pubs.publication-statusPublished

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