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"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.

Demographic characteristics, severity of illness, resource utilization, and outcome were compared for 351 medical ICU (MICU) and 329 ward patients of a large, urban, tertiary care hospital. Patients were similar in age, race, sex, and insurance coverage. Both MICU and ward patients had similar health status distributions 3 to 6 months before hospitalization. Severity of illness, as measured by the Acute Physiology Score was significantly higher in the MICU patients, although there was considerable overlap in the distributions. Resource utilization, as measured by the Therapeutic Intervention Scoring System (TISS), was also significantly higher in the MICU; again, the distributions of the two groups overlapped, although mostly for low values of TISS. Of the MICU sample, 28% to 30% never required active therapeutic interventions; 11% of the ward sample received active treatment. The significant overlap between MICU and ward distributions of severity of illness and resource utilization has implications for admission and discharge policies.