A recent study found that prohibition of resuscitation (DNR) orders usually lead to increased mortality and negative health outcomes. 

Jonathan Baktari, MD, President and CEO of e7 Health, a medical laboratory, conducted a literature review of 10 existing peer-reviewed studies on this topic. He told Fierce Healthcare that he did so after coming to the surprising conclusion that there was no such data collection. His comment does not include every study on the subject.

Baktari believes that the result is enough to remove a drug. He said, "DNR did not receive the same critical evaluation that we had for potential surgery or procedures or diagnostic tests or drugs." Baktari emphasized that this is not the improper use of DNR, but the follow-up treatment that the patient receives after receiving the DNR order. He acknowledged that DNR can be an important tool for empowering patients and alleviating potential pain.

Several studies have found that DNR patients have a higher mortality rate due to reasons unrelated to the order of DNR. A study found that more than 13% of surgical patients with DNR died within 30 days after surgery, compared with 5.6% of patients without DNR. This difference is more pronounced in vascular surgery patients: Compared with patients without DNR (2%), patients with DNR are more likely (9%) to experience transplant failure, and 35% of patients die within 30 days after surgery. For patients without DNR, the rate was 14% DNR. 

Among stroke patients, almost half of the patients designated as DNR within the first 24 hours of hospitalization died in the hospital, while the surviving rate was only 13%. 

Baktari pointed out in the study that DNR does not mean that patients want less care or treatment than patients who are not ordered. However, “in many hospitals, DNR may also stand for DNT (no treatment),” he wrote. When examining the perception of cancer patients, a study found that 11% of clinicians believed that DNR orders meant "comfort measures." 

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Other studies have found that DNR orders have led to a reduction in overall care, including obtaining blood samples, changing central lines, and blood transfusions. A study found that residents are also unlikely to provide treatments such as dialysis or intensive care transfers to DNR patients, even though the patients or their family members were not told to give up these measures.

Baktari pointed out in the study: “There is no single national DNR standard for healthcare providers. This difference means that even in the same city, patients in different hospitals can get completely different care.” Baktari pointed out that there are several states. A portable medical order plan has been developed to help patients provide detailed information about the exact treatment they want or don't want. It is intended to complement the DNR command. 

Baktari said that although there was training on the benefits of DNR at the medical school, there was little discussion of potential negative effects. This comment is "irrefutable", that is, a certain culture or mentality about DNR prevails in all types of clinical roles in the healthcare environment. "It's hard to refute," he said. To help respond to these related trends, Baktari believes that admitting that there are problems and receiving education on how to solve them is the key. Every clinician needs to understand that the DNR order does not mean that patients need less medical care-and there should be a set of standardized standards to use DNR throughout the healthcare system.

"There are ways to make DNR less subjective," he said.

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