The effect of do-not-resuscitate orders on length of stay
George A. Kanoti, STDAddress reprint requests to G.A.K., Department of Bioethics, P37, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
William R. Gombeski, MBA, MPH
A. Dale Gulledge, MD
Dale Konrad, MBA
Robert Collins, MD
Sharon V. Medendorp, MPH
In 1988, a new do-not-resuscitate policy aimed at assisting professional staff, nurses, patients, and families in end-of-life choices replaced the existing policy at The Cleveland Clinic Foundation. We conducted a retrospective chart review to examine the effects of the new policy on length of stay. Data were collected on demographics, clinical information, length of stay, and the frequency of do-not-resuscitate orders for expired Medicare patients in 1987 (n=125) and 1989 (n=135). Length of stay for patients who received a do-not-resuscitate order was significantly reduced in 1989 compared with 1987, partly because the orders were issued earlier in patients' stays in 1989. The number of days from writing the order until death did not change significantly from 1987 to 1989. We conclude that a well-defined do-not-resuscitate policy can reduce length of stay.