Frequency and Factors Associated With the Implementation of a Do-Not Resuscitate Order in Patients Admitted for Rehabilitation in a Post-Acute Care Unit: A Retrospective Cohort Study

Abstract

Background: Some patients in the post-acute recovery phase have poor prognosis and may benefit from a palliative care approach. However, little is known about potential gaps regarding palliative care needs in this population. Methods: This is a retrospective cohort of patients transferred from an acute hospital to a post-acute care unit with the aim of rehabilitation. The aim was to analyze factors associated with the implementation of a do-not-resuscitate (DNR) order during hospitalization, as a surrogate of clinical decline and palliative care needs. Multivariate analysis was performed to control for confounders. Results: There were 1143 individuals included in the study, of which 415 (36.3%) had a DNR order instituted during hospitalization. After adjusting for confounders, the following variables were positively associated with DNR implementation: age (OR = 1.06, 95% IC: 1.04-1.07, P < 0.001); use of a tracheostomy (OR = 1.65, 95% IC: 1.08-2.51, P = 0.019) and feeding tube (OR = 1.97, 95% IC: 1.37-2.82, P < 0.001) at admission. Functional improvement, as measured by a positive variation in the functional independence measure (FIM) scale was negatively associated with DNR implementation (OR = 0.94, 95% IC: 0.93-0.95, P < .001). Conclusion: This study contributes to understanding the frequency and factors associated with the need for palliative care in patients admitted for rehabilitation in a post-acute care unit. The identification of factors associated with DNR implementation in post-acute care may improve clinicians’ decision-making when transitioning those patients from acute hospitals.