Do-Not-Hospitalize Orders Rarely Used
Do-not-hospitalize orders rarely used, but they could cut unnecessary hospital stays for skilled nursing facility residents. The use of the do-not-hospitalize order cuts emergency department visits and hospital stays according to new research.
Researchers from Rutgers University and the State University of New York at Albany analyzed data from over 6,000 nursing facility residents to determine the impact of DNH orders. Their findings showed that 61% of residents had a do-not-resuscitate order and only 12% had a do-not-hospitalize order in their medical charts.
Residents with the DNH order had significantly fewer unnecessary hospital stays and emergency room visits in the last days of their life as compared to those who did not have the DNH order.
Skilled nursing facility providers based on this study should encourage residents and their family members to complete a do-not-hospitalize order. The order should express the residents values and goals in guiding their care provisions toward their end of life care.
The greatest expense for the health care system in this country comes in the last years of an individuals life. We are a product of our own success. Medical science has extended life in this country by making great strides in treating heart issues and chronic illnesses. These new procedures that did not exist 30 years ago are costly, yet we want the health system to reduce the annual expenditures from Medicare and Medicaid. This is never going to happen, what can happen is that we reduce the growth rate for health care, we become more efficient and quality of care improves.
Using tools like the do-not-hospitalize order, while still providing quality care for the end of life can also reduce the cost to the system. Nursing facilities have become very sophisticated in caring for chronically ill residents, coupled with hospice care their is no reason why a resident at the end of his/her life would need to be moved to a hospital two or three times during the process. It is traumatic for the patient, the family and unnecessarily costly to the system.
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