Prevalence, Predictors and Outcomes of Documented DNR and/or DNI Orders in COVID-19 Patients (S522)

Abstract

Outcomes: 1. Understand the prevalence, predictors, and outcomes associated with DNR and DNI orders for hospitalized patients with COVID-19 throughout the pandemic

2. Understand the reasons for differences in code status order utilization for hospitalized patients with COVID-19 throughout the pandemic

Original Research Background: The COVID-19 pandemic created complex challenges regarding timing and appropriateness of do not resuscitate (DNR) and do not intubate (DNI) orders.

Research Objectives: This study sought to determine the prevalence, predictors, timing, and outcomes associated with having a documented DNR or DNI order for hospitalized patients with COVID-19.

Methods: A retrospective multisite chart review of hospitalized patients with COVID-19 was performed to determine characteristics, medical treatments received, and outcomes associated with having a documented DNR or DNI order. Patients were divided into two cohorts (early and late) by timing of hospitalization during the pandemic.

Results: Among 1,358 hospitalized patients with COVID-19, 19% (n = 259) had a documented DNR or DNI order. In multivariate analysis, age (older) (p < .01, OR 1.13), race (White) (p = .01, OR 0.55), and hospitalization during the early half of the pandemic (p = .02, OR 1.8) were associated with having a DNR or DNI order. Palliative care consultation occurred more often in the early cohort (p < .01). Medical treatments, including ICU (p = .31) and level of ventilator support (p = .32) did not differ between cohorts. Hospital mortality was similar between the early and late cohorts (p = .27); however, among hospital decedents median hospital day from DNR or DNI order to death differed between cohorts (p < .01) (6 days from order to death in early vs 2 days in the late cohort).

Conclusion: More frequent use of DNR orders and orders written farther from death in decedents characterized the early pandemic phase. White patients were more likely to have DNR or DNI orders, consistent with prior research.

Implications for Research, Policy, or Practice: Uncertainty in prognosis may have played a role in the frequency and timing of DNR and DNI orders early in the pandemic. Additional factors, such as fear of resource shortage and transmission of COVID-19 to healthcare workers, may have also played a role.