Code Status Blues: Do Physicians Order Do-Not-Resuscitate (DNR) Less Often Since Texas Enacted DNR Law? (W205A)

Abstract

1.Explain whether a legally mandated policy change to physician workflow affected an institution’s ability to implement patients’ code status preferences.2.Develop ideas for further research to explore whether creating policies to govern implementation of patients’ wishes actually improves understanding and communication of patients’ wishes among care teams. Respecting patients’ autonomous wishes is crucial to providing quality end-of-life care. Do-Not-Resuscitate (DNR) orders for patients who request them is a critical part of such care. On April 1, 2018, Texas implemented Senate Bill 11. This law mandates extra steps physicians must take to document consent from hospitalized patients prior to ordering DNR. This study investigated whether inpatient DNR order utilization decreased after the law took effect. We conducted a retrospective cohort chart review of all adults admitted to an academic urban tertiary care hospital in Texas during the three years immediately before and the year immediately after the law’s implementation. We reviewed all code status orders for the 5,426 sickest patients. The primary outcome is the proportion of patients who had DNR in effect at the end of their hospitalizations. Before the law went into effect, the proportion of patients with DNR orders was 40.4%; after the law, the proportion of patients with DNR orders dropped to 36.3%, a result that is significant with a p value of 0.004. This study shows a significant decrease in inpatient DNR order utilization in the study institution following the law’s implementation.