Third of UK hospital Covid patients had ‘do not resuscitate’ order in first wave
Almost a third of patients admitted to hospital with suspected Covid-19 during the first wave of the pandemic had a “do not resuscitate” decision recorded before or on their day of admission, research suggests.
This is higher than the rates reported in previous studies of conditions similar to Covid-19 before the pandemic, according to a study from the University of Sheffield’s School of Health and Related Research (ScHARR), one of the first to quantify the use of such orders in the pandemic.
The research, published in the journal Resuscitation, found that 59% of patients with a do not attempt cardiopulmonary resuscitation (DNACPR) decision survived their acute illness and 12% received intensive treatment aimed at saving their life.
The study, funded by the National Institute for Health Research, found 31% of patients admitted to UK hospitals with suspected Covid-19 during the first wave of the pandemic had a DNACPR decision recorded before or on their day of admission to hospital.
People with a DNACPR decision received some intensive treatments as frequently as those with no DNACPR decision, researchers found, which provides reassurance that doctors were not denying patients with DNACPR decisions potentially life-saving treatment.
The research also found that people of Asian ethnicity were less likely to have a DNACPR decision on or before their day of admission to hospital.
The reasons for this are not clear and the researchers highlighted the need for further studies into the discussions that take place when people from ethnic minorities are admitted to hospital with Covid-19 or other serious illnesses.
The findings come from the University of Sheffield-led Priest study, which was originally set up to evaluate ways of assessing the severity of Covid-19 in people attending emergency departments.
The research team analysed data relating to DNACPR decisions from 12,748 adults in the study after the Care Quality Commission (CQC) undertook a review of the use of DNACPR decisions in the pandemic.
In March, the CQC called for ministerial involvement to tackle the “worrying variation” in people’s experiences of DNACPR decisions, with some families not properly involved and others unaware that decisions had been made.
It said that a combination of “unprecedented pressure” on providers and “rapidly developing guidance” may have led to situations where DNACPR decisions were incorrectly conflated with other clinical assessments.
There were examples of good practice but the regulator also found a
“worrying picture” of poor involvement of people using services, poor record keeping, and a lack of oversight and scrutiny of the decisions being made.