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Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital

Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialtie...

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Autores principales: Plymire, Christopher J., Miller, Elissa G., Frizzola, Meg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306927/
https://www.ncbi.nlm.nih.gov/pubmed/30544741
http://dx.doi.org/10.3390/children5120164
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author Plymire, Christopher J.
Miller, Elissa G.
Frizzola, Meg
author_facet Plymire, Christopher J.
Miller, Elissa G.
Frizzola, Meg
author_sort Plymire, Christopher J.
collection PubMed
description Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors influencing EOL care in pediatrics. We examined the time preceding and following the implementation of a pediatric palliative care team (PCT) via a 5-year, retrospective chart review of all deceased patients previously admitted to inpatient services. Thirty-five percent (167/471) of the patients in our study died with a DNR order in place. Sixty-two percent of patients died in an ICU following DNR order placement. A difference was noted in DNR order timing between patients on general inpatient units and those discharged to home compared with those in the ICUs (p = 0.02). The overall DNR order rate increased following the initiation of the PCT from 30.8% to 39.2% (p = 0.05), but no change was noted in the rate of death in the ICUs. Our study demonstrates a variation in the timing of death following DNR order placement when comparing ICUs and general pediatric floors. Following the initiation of the PCT, we saw increased DNR frequency but no change in the interval between a DNR order and death.
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spelling pubmed-63069272019-01-02 Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital Plymire, Christopher J. Miller, Elissa G. Frizzola, Meg Children (Basel) Article Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors influencing EOL care in pediatrics. We examined the time preceding and following the implementation of a pediatric palliative care team (PCT) via a 5-year, retrospective chart review of all deceased patients previously admitted to inpatient services. Thirty-five percent (167/471) of the patients in our study died with a DNR order in place. Sixty-two percent of patients died in an ICU following DNR order placement. A difference was noted in DNR order timing between patients on general inpatient units and those discharged to home compared with those in the ICUs (p = 0.02). The overall DNR order rate increased following the initiation of the PCT from 30.8% to 39.2% (p = 0.05), but no change was noted in the rate of death in the ICUs. Our study demonstrates a variation in the timing of death following DNR order placement when comparing ICUs and general pediatric floors. Following the initiation of the PCT, we saw increased DNR frequency but no change in the interval between a DNR order and death. MDPI 2018-12-10 /pmc/articles/PMC6306927/ /pubmed/30544741 http://dx.doi.org/10.3390/children5120164 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Plymire, Christopher J.
Miller, Elissa G.
Frizzola, Meg
Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
title Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
title_full Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
title_fullStr Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
title_full_unstemmed Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
title_short Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital
title_sort retrospective review of limitations of care for inpatients at a free-standing, tertiary care children’s hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306927/
https://www.ncbi.nlm.nih.gov/pubmed/30544741
http://dx.doi.org/10.3390/children5120164
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