Consequences of end-of-life physician orders: Economic and hospital policy implications.

Abstract

The University Medical Center in Tucson, Arizona developed and implemented a procedure-specific Limitation of Medical Care (LMC) form on December 1, 1989 to address medical futility and lack of clarity in do-not-attempt-resuscitation (DNAR) orders. A retrospective review of two years of data, with 300 usable responses, showed an increased amount of participation by patients and their surrogates in the DNAR decision with the LMC form. Use of the form was also associated with an increased number of medical interventions specified to be withheld after a DNAR or LMC order was written. There was no decrease in expenditures or length of survival associated with use of the form, nor was there a decrease in the number of codes called for patients who had an order that resuscitation was not to be attempted. An average $13,347 of charges were accrued in the ICU for patients in the pre-form group, $4,314 on average being after a DNAR order was written. An average $21,957 of charges were accrued in the ICU for patients in the post-form group, $8,733 on average being after a DNAR order was written. An average $20,523 of total charges were accrued for patients in the pre-form group, $7,156 on average being after a DNAR order was written. An average $29,830 of total charges were accrued in the ICU for patients in the post-form group, $12,550 on average being after a DNAR order was written. Recommendations for the UMC Bioethics Committee and future research suggestions are presented.