'Do-not-hospitalize' orders reduce hospital or emergency room visits, but few patients have them

Do-not-hospitalize orders help reduce the number of hospital stays and emergency department visits for nursing home residents, but they are used by only a small percentage of patients, according to a new study led by researchers at UAlbany.

Publishing in the May issue of JAMDA, the authors conducted a cross-sectional study of patients in skilled nursing facilities. They found that while 61 percent of nursing home residents have 'do-not-resuscitate' orders, only six percent have 'do-not-hospitalize' orders in place. Twelve percent of patients had feeding restrictions. The findings suggest that nursing home residents may be subjected to unwanted hospital or emergency room visits that are contrary to their expressed values and goals for end-of-life care.

"We set out with the goal of examining whether an advanced 'Do Not Hospitalize' directive would be effective in reducing hospital/emergency department transfers," said Taeko Nakashima, a visiting assistant professor in the department of Health Policy Management and Behavior at UAlbany's School of Public Health. "The results show that for residents without DNH orders, the odds of being transferred to a hospital was significantly higher."

The findings suggest skilled nursing providers should encourage residents to complete DNH orders, so that their end-of-life health care wishes are respected, Nakashima said.

"Residents with DNH orders had significantly fewer transfers," said Nakashima. "This suggests that residents' end-of-life care decisions were respected and honored. Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident's values and goals in guiding care provision toward the end of life."

According to the findings, residents with DNH orders had significantly fewer unnecessary hospital stays and emergency department visits in their last 90 days of life than residents without them, the researchers reported. The orders also helped reduce hospital stays for residents with dementia.