U.S. Physicians More Likely to Choose Do-Not-Resuscitate for COVID-19

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As cases of COVID-19 continue to surge in cities nationwide, hospitals and physicians are facing unprecedented demands. Physical resources such as personal protective equipment (PPE) and ventilators are at a premium, and providers are working to care for COVID-19 patients while mitigating their own risk of infection. As they confront these challenges, hospitals and physicians are being forced to make ethical decisions about patient care many have never faced before.

New research by Sermo, an online community of physicians who provide feedback on current medical trends and topics, shows a dramatic difference in how U.S. physicians approach triage protocol for COVID-19 patients versus physicians elsewhere in the world. 

Here are key findings from Sermo’s survey of nearly 5,000 global physician respondents in 30 countries including the United States, Canada, Germany, Italy, South Korea, the United Kingdom, Japan, India and China. (View Sermo's full methodology.)

1. U.S. doctors were three times more likely to choose do-not-resuscitate for COVID-19 patients than doctors in other countries.

The COVID-19 crisis is changing the “all hands” approach to patients who code, as hospitals work to protect physicians and other healthcare staff from exposure to the novel coronavirus. Some hospitals have even considered universal do-not-rescusitate orders for COVID-19 patients in an effort to protect limited resources.

In the Sermo survey, 14% of American physician respondents said their personal choice would be do-not-resuscitate (DNR) for COVID-19 patients, compared to 5% of respondents from the rest of the world. 

2. More than half of physicians said they would limit healthcare teams’ exposure when providing life-saving measures for COVID-19 patients.

When evaluating options for an “all measures” approach for COVID-19 patients who code, 53% of physicians said they would make life-saving efforts, but limit the number of healthcare professionals (HCPs) working on the patient. This protocol aims to reduce the risk of exposure among providers, which in turn prevents the loss of available resources if physicians, nurses and other HCPs become infected.

More than a quarter of surveyed physicians (26%) said hospitals should use all life-saving measures for COVID-19 patients who code, with as many HCPs as needed.

3. U.S. doctors reported a lower percentage of hospitals making protocol adjustments for ventilator shortages than those in other countries.

At the time of the Sermo survey in late March 2020, 69% of global hospital physician respondents said their hospitals had updated protocols for deciding which patients receive a ventilator if supplies are limited. In the U.S. roughly half (53%) of hospital doctors treating COVID-19—and 55% of New York physicians specifically—reported changes in protocol for ventilator shortages. With U.S. numbers removed, 75% of doctors in Europe and all other countries said their hospitals had made protocol adjustments for limited ventilator availability.

4. The ethical criteria for prioritizing use of ventilators differ slightly between physicians and hospitals.

Sermo asked respondents to consider ventilator prioritization on factors including patients with the highest chance of recovery, patients most critically ill or at highest risk of dying, first responders, patient age, and first-come-first-served. 

Hospitals and physicians agree on the first two levels of hierarchy, placing patients with the highest chance of recovery at the top, followed by those most critically ill or with highest risk of death. However, doctors listed first responders as the third criterion, while hospitals said the age of the patient should be considered ahead of first responder status.

All respondents ranked first-come-first-served as the least important criterion for prioritizing ventilators in the case of a shortage.

5. Globally, 11% of physician respondents said they did not know which protocol they would choose for COVID-19 patients who code.

This significant percentage of doctors who replied that they did not know which protocol was best for COVID-19 patients in crisis reflects the heart-wrenching situations many physicians are facing for the first time. Even as social distancing measures work to reduce the surge of patients, hospitals still face an overwhelming need for care and an often-dwindling supply of resources to provide it. By taking proactive steps to evaluate triage situations and establish clear guidelines for COVID-19 care, hospitals and physicians can be ready to support each other through this crisis—both professionally and emotionally—and provide the highest level of care possible for their patients.

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  1. Sermo reports on life or death decisions: US physicians are 3 times as likely to say do-not-resuscitate should be the protocol for COVID patients who code vs physicians in other countries. Sermo.com. https://www.sermo.com/press-releases/category/week-of-0413/
  2. COVID-19 Real Time Barometer Survey Methodology. Sermo.com. https://public-cdn.sermo.com/COVID-19-Real-Time-Barometer-Survey-Methodology.pdf
  3. Hospitals consider universal do-not-resuscitate orders for coronavirus patients. Washington Post. https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/