Read on Twitter
There's a new study of >49K patients in CA published @CritCareMed. Anyone who cares about end-of-life care, #ICU care, #PalliativeCare, geriatrics, #EmergencyMedicine, #bioethics, multi-level modeling, or patient-centered care should have a look.
@WalkeyAllan @PAIRCenter
1/
@WalkeyAllan @PAIRCenter
1/
Eligibility: Inpatients with DNR orders in the first 24 hours who were discharged and then readmitted within 30 days.
Hypothesis: If DNR reversals happen because patients change their minds, the rate of DNR reversal will be similar across hospitals. 2/
Hypothesis: If DNR reversals happen because patients change their minds, the rate of DNR reversal will be similar across hospitals. 2/
You're more likely to have your DNR order reversed if you're readmitted to a different hospital (39% vs 60%).
But what's driving whether you keep your DNR order is practice norms.
At 4th quartile hospitals, 27% of orders get reversed.
At 1st quartile hospitals it's 77%. 3/
But what's driving whether you keep your DNR order is practice norms.
At 4th quartile hospitals, 27% of orders get reversed.
At 1st quartile hospitals it's 77%. 3/
Not surprisingly, hospitals with low DNR rates overall - ie where most patients are full code - were also the hospitals most likely to reverse a patient's DNR order.
Those hospitals with DNR rates<10% & reversal rates >60%?
I would *love* to know more about those places. 4/
Those hospitals with DNR rates<10% & reversal rates >60%?
I would *love* to know more about those places. 4/
Don't wave your hands at me and say "confounding" just because these results are uncomfortable.
An unmeasured confounder would need an aOR of 5.3 in order to change the association between hospital quartile and DNR reversal rate.
(MAJOR KUDOS for reporting an e-value!
) 5/
An unmeasured confounder would need an aOR of 5.3 in order to change the association between hospital quartile and DNR reversal rate.
(MAJOR KUDOS for reporting an e-value!
) 5/
Yes, some portion of DNR reversals are the result of changes in patient preferences.
But hospitals - and the doctors who work there - clearly have a HUGE impact too.
"DNR reversals not directly linked to patient preferences may lead to care inconsistent with patient goals."
But hospitals - and the doctors who work there - clearly have a HUGE impact too.
"DNR reversals not directly linked to patient preferences may lead to care inconsistent with patient goals."
