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Wu CY, Jen CH, Chuang YS, Fang TJ, Wu YH, Wu MT. Factors associated with do-not-resuscitate document completion among patients hospitalized in geriatric ward. BMC Geriatr 2021; 21:472. [PMID: 34433419 PMCID: PMC8386141 DOI: 10.1186/s12877-021-02407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With a rapidly aging population, there is an increasing need for do-not-resuscitate (DNR) and advance care planning (ACP) discussions. This study investigated the factors associated with signing DNR documents of older patients in the geriatric ward. METHODS We conducted a retrospective cohort study at a geriatric ward in a tertiary hospital in Southern Taiwan. Three hundred and thirty-seven hospitalized older patients aged ≥65 years in the geriatric ward from 2018 to 2019. The Hospital Information System and electronic medical records were accessed to obtain details regarding patients' demographics, daily living activities, serum albumin level, nutrition screening score, intensive care unit transferal, resuscitation procedure, days of hospital stay, and survival status on discharge, and DNR status was recorded retrospectively. Patients were classified into DNR and non-DNR groups, with t-tests and Chi-square tests applied to compare the differences between groups. Logistic regression was performed to predict factors related to the DNR documents. RESULTS A total of 337 patients were included, 66 of whom had signed a DNR during hospitalization. After multivariate logistic regression, age 85 or more compared to age 65-74 (adjusted odds ratio, aOR 5.94), poor nutrition with screening score two or more (aOR 2.71), albumin level less than 3 (aOR 3.24), Charlson Comorbidity Index higher than 2 (aOR 2.46) and once transferred to ICU (aOR 5.11) were independently associated with DNR documentation during hospitalization. CONCLUSIONS Several factors related to DNR documents for geriatric patients were identified which could provide clinical information for physicians, patients, and their families to discuss DNR and ACP.
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Affiliation(s)
- Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Hao Jen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yun-Shiuan Chuang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Tzu-Jung Fang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Yu-Hsuan Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Ming-Tsang Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan. .,Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan. .,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan. .,Program of Environmental and Occupational Medicine and Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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Kelly AM, Keijzers G, Klim S, Craig S, Kuan WS, Holdgate A, Graham CA, Jones P, Laribi S. Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments. Age Ageing 2021; 50:252-257. [PMID: 32997140 DOI: 10.1093/ageing/afaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region. METHODS A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72-h periods and included demographics, co-morbidities, mode of arrival, usual medications, ED investigations and treatment, ED diagnosis and disposition, and outcome. The primary outcomes of interest are the epidemiology and outcome of patients aged 75 years or older presenting to the ED with dyspnoea. RESULTS 1097 patients were included. Older patients with dyspnoea made up 1.8% [95% confidence interval (CI) 1.7-1.9%] of ED presentations. The most common diagnoses were heart failure (25.3%), lower respiratory tract infection (25.2%) and chronic obstructive pulmonary disease (17.6%). Hospital ward admission was required for 82.6% (95% CI 80.2-84.7%), with 2.5% (95% CI 1.7-3.6%) requiring intensive care unit (ICU) admission. In-hospital mortality was 7.9% (95% CI 6.3-9.7%). Median length of stay was 5 days (interquartile range 2-8 days). CONCLUSION Older patients with dyspnoea make up a significant proportion of ED case load, and have a high admission rate and significant mortality. Exacerbations or worsening of pre-existing chronic disease account for a large proportion of cases which may be amenable to improved chronic disease management.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Australia and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, St Albans, VLC, Parkville, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia and School of Medicine, Bond University, Gold Coast, QLD, Australia and School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Sharon Klim
- Joseph Centre for Emergency Medicine Research @ Western Health, Sunshine, Australia and The University of Melbourne, Parkville, Australia
| | - Simon Craig
- Emergency Department, Monash Medical Centre, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia and Murdoch Children’s Research Institute, Parkville, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Health System, Singapore and Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore
| | - Anna Holdgate
- Department of Emergency Medicine, Liverpool Hospital, Sydney, Australia and University of New South Wales (Southwest Clinical School), Sydney, Australia
| | - Colin A Graham
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Peter Jones
- Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, 37044 Tours, France
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Bryant J, Waller A, Pickles R, Hullick C, Price E, White B, Willmott L, Bowman MA, Knight A, Ryall MA, Sanson-Fisher R. Knowledge and confidence of junior medical doctors in discussing and documenting resuscitation plans: A cross-sectional survey. Intern Med J 2020; 51:2055-2060. [PMID: 32687240 DOI: 10.1111/imj.14994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/06/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A Resuscitation Plan is a medically authorised order to use or withhold resuscitation interventions. Absence of appropriate resuscitation orders exposes patients to the risk of invasive medical interventions that may be of questionable benefit depending on individual circumstances. AIMS To describe among junior doctors: (1) self-reported confidence discussing and completing resuscitation plans; (2) knowledge of resuscitation policy including whether resuscitation plans are legally enforceable and key triggers for completion; and (3) the factors associated with higher knowledge of triggers for completing resuscitation plans. METHODS A cross-sectional survey was conducted at five hospitals. Junior doctors on clinical rotation were approached at scheduled training sessions, before or after ward rounds, or at change of rotation orientation days and provided with a pen-and-paper survey. RESULTS A total of 118 junior doctors participated. Most felt confident discussing (79%, n = 92) and documenting (87%, n = 102) resuscitation plans with patients. However, only 45% of doctors (n = 52) correctly identified that resuscitation plans are legally enforceable medical orders. On average, doctors correctly identified 6.8 (SD = 1.8) out of 10 triggers for completing a resuscitation plan. Doctors aged >30 years were four times more likely to have high knowledge of triggers for completing resuscitation plans (OR 4.28 (95% CI 1.54 to 11.89), p = 0.0053). CONCLUSION Most junior doctors feel confident discussing and documenting resuscitation plans. There is a need to improve knowledge about legal obligations to follow completed resuscitation plans, and about when resuscitation plans should be completed to ensure they are completed with patients who are most at risk. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy Waller
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rob Pickles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Carolyn Hullick
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Emma Price
- John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Ben White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ms Alison Bowman
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Anne Knight
- Manning Education Centre University of Newcastle Department of Rural Health 69a High St Taree, New South Wales, Australia
| | - Mary-Ann Ryall
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Central Coast Clinical School, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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