The Do Not Hospitalize (DNH) order is a specific medical directive that forms an important part of a person’s advance care planning. This physician’s order is designed to align a patient’s medical treatment with their expressed goals, particularly for those who have serious chronic illnesses or are nearing the end of life. A DNH order directs healthcare providers not to transfer the patient to an acute care hospital for treatment during a health crisis. The order reflects a patient’s preference to receive care in their current, familiar setting, avoiding the often burdensome and disorienting environment of an emergency department and hospital admission.
Defining the Scope of a DNH Order
A Do Not Hospitalize order prohibits emergency transport to an acute care facility when a patient experiences a medical decline. This directive is most frequently utilized for individuals residing in long-term care facilities, skilled nursing facilities, or hospice settings where aggressive, curative interventions are no longer the primary goal of care. The intent is to prioritize comfort and continuity of care over intervention that may not improve the person’s quality of life.
It is a common misunderstanding that a DNH order means a cessation of medical care; the directive does not mean “do not treat.” Instead, the order mandates that all appropriate comfort measures, symptom management, and medical treatments that can be safely administered within the current location must be provided. For instance, a patient with a DNH order who develops pneumonia would receive antibiotics, oxygen, and pain control at their facility, rather than being subjected to a disruptive hospital transfer. The order shifts the focus from aggressive, location-dependent intervention to palliative support.
DNH vs. DNR: Understanding the Key Differences
The DNH order is distinct from the more widely known Do Not Resuscitate (DNR) order, though the two are often confused and may coexist on the same forms. A DNR order applies specifically to cardiopulmonary resuscitation (CPR) and related life-sustaining measures, such as mechanical ventilation, after the patient’s heart or breathing stops. This decision focuses on the type of intervention used at the moment of cardiac or respiratory arrest.
In contrast, a DNH order focuses entirely on the location of care and the decision to avoid emergency transfer to an acute care setting. It prevents the patient from being moved by ambulance to a hospital when their condition worsens. A patient can have a DNH order and still be a “Full Code” for resuscitation, meaning they would receive CPR at their current facility should they suffer cardiac arrest. The DNH order represents a decision about where care is delivered, while the DNR order specifies which life-saving interventions are permitted.
The Process of Implementing a DNH
Establishing a DNH order requires informed consent and physician documentation. The order must be discussed thoroughly with the patient or their legally appointed surrogate decision-maker, such as a healthcare proxy or agent. This conversation ensures the decision-maker fully understands the risks and benefits of foregoing hospital care and that the order aligns with the patient’s values and goals.
Once consent is obtained, a physician must sign the order, translating the patient’s wishes into a medical directive. This order is frequently documented on standardized, state-specific forms, such as a Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Life-Sustaining Treatment (POLST) form. Using these portable forms is essential because it ensures the DNH directive is clearly communicated and honored across different healthcare settings, including by Emergency Medical Services (EMS) personnel.
Who Can Revoke or Change the Order?
A DNH order is not a permanent directive; it remains an expression of the patient’s current healthcare preferences. The patient retains the right to revoke or change the order at any time, provided they still possess the capacity to make medical decisions. Patient autonomy is paramount, and reversing the DNH status requires only a simple conversation with the physician.
If the patient lacks decision-making capacity, the legally appointed healthcare agent or surrogate is responsible for communicating any changes to the physician. A significant change in the patient’s medical condition or a shift in their goals of care should prompt the care team to review the DNH status. Regular review of the order ensures that the DNH directive continues to reflect the patient’s best interest and current wishes.