DNH orders could significantly reduce ER visits: JAMDA study

Does the use of “Do Not Hospitalize” (DNH) orders reduce the number of visits to the emergency department (ED)? Yes, but a dementia diagnosis can affect the rates, notes a study published in JAMDA based on more than 43,000 nursing home residents in New York state.

While about 61 percent of nursing home residents in the study had a Do Not Resuscitate (DNR) order, only 6 percent had a DNH order.

Residents with DNH orders experienced less than half as many hospital stays and fewer ED visits in the last 90 days than those without DNH orders.

Residents with dementia who had a DNH order had significantly fewer hospital stays than those without a DNH order (2.7 percent vs 6.3 percent) but still visited the ED as much or more that then counterparts with no DNH.

As nursing homes continue to focus on person-centered care, improving residents’ understanding of DNR and DNH forms can preserve residents’ care delivery wishes, the study authors write. “Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident's values and goals in guiding care provision toward the end of life.”

Topics: Executive Leadership