Most patients receiving end-of-life care want to avoid aggressive attempts to prolong their life, but medical culture and practices often contradict these wishes. Part of the problem is due to confusion surrounding do-not-resuscitate orders. Here’s what patients really need to know about the “no code.”
First-responders would likely ignore any DNR-themed jewelry, markings, or tattoos, and only a specific form from the health sector specifically targeted at first-responders would stop them from providing standard care. Are first responders going to rifle through your pockets looking for such a form while they’re trying to save your life? Probably and hopefully not. The hospital setting, however, is where living wills, DNR-orders, powers-of-attorney, next-of-kin, etc. can be more readily honoured and better detailed. You could probably check the policies in your own jurisdiction for clarification.
In recent years, perhaps in response to an uptick in inquiries about hospital performance and its effect on patient outcomes, a number of programs have been developed to help hospitals track how the patients they care for do. The most prominent of these is the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). This system allows hospitals to compare their performance relative to that of other participating hospitals and provides them with detailed descriptions of patient outcomes as adjusted for the patients’ risks.
Since 1994, the ACS NSQIP has been tracking data on 135 patient-related variables. As its name implies (Quality Improvement Program), the hope is that this will lead to improvements for patient care—having this information will hopefully motivate hospitals to improve their outcomes and reduce the payments charged to Medicare. However, there has not been a study examining whether this expectation has been met until now. The new study published in JAMA seems to indicate that a hospital’s participation in this outcomes/costs-tracking program does not directly lead to improved patient care or reduced Medicare costs.
For the last two years, the US$2.25 million Nokia Sensing X Challenge has lured entrants from around the globe to submit groundbreaking technologies that improve access to health care. A panel of experts have awarded this year’s grand prize to Massachusetts-based DNA Medical Institute (DMI), whose hand-held device is capable of diagnosing ailments in minutes, using only a single drop of blood.