Analysis and corresponding strategy of emergency patients forgoing the invasive rescue therapy

Abstract

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy. Methods According to whether the patients accepted the invasive rescue therapy or not, 2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR). There were 2 147 cases in group R and 526 case in group DNR. The rescue consent form or do not rescue consent form was required to sign by patient self, patient's family member or relatives. The patient's basic information, underlying disease, payment of medical expenses, personnel who signed the consent form, treatment and prognosis in both groups were investigated. Results There was no significant gender deference in both groups(χ2=1.86, P=0.173). The mean age of patients in group DNR was much higher than that in group R (69.5±12.5 vs. 58.6±19.2 years, F=28.92, P=0.000). The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90% vs.44.01%, χ2=10.59, P=0.001). The ratios of chronic heart failure, chronic respiratory failure, chronic hepatic encephalopathy, chronic renal failure, malignant tumor in group DNR were significantly higher than that of group R (8.17% vs.3.03%, 8.17% vs.2.61%, 3.80% vs.1.16%, 5.32% vs.1.44%, 11.98% vs.2.28%, all P=0.000). The proportion of patients without insurance in group DNR was higher than that of group R (52.09% vs.41.08%, χ2=20.87, P=0.000). Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04%vs.0.42%, χ2=64.40, P=0.000), there were no significant deference in other people who signed the consent form such as patient's offspring, spouse, parents, siblings and others. Univariate and multivariate logistic regression analyses showed older age, non Beijing patients, chronic underlying diseases, without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy. The mortality rate of group DNR was much higher than that of group R (19.39% vs.7.68%, χ2=64.40, P=0.000). Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease. The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain. Key words: Emergency patients; Resuscitation room; Forgoing the invasive rescue therapy; Reason; Underlying disease; Payment of medical expenses; Logistic regression analysis; Strategy