A Do Not Hospitalize (DNH) order is a medical directive used in advance care planning to keep patients in their current residence for care, especially during a health crisis. It is commonly used for individuals in long-term care facilities (LTCFs), nursing homes, or those receiving hospice care at home. The purpose of a DNH is to ensure comfort and stability by preventing disruptive transfers to an acute care hospital. This decision prioritizes the patient’s quality of life and comfort over aggressive, life-prolonging interventions that require hospitalization.
What a Do Not Hospitalize Order Means
A DNH order explicitly instructs healthcare providers and facility staff not to send a patient to an emergency room or admit them to a hospital if their medical condition declines. For many patients, especially the elderly or those with advanced chronic illnesses, a transfer to an unfamiliar hospital environment can cause distress, confusion, and functional decline. The intent is to maintain the patient’s familiar surroundings and routine, supporting their overall well-being.
Hospitalization itself carries risks, such as exposure to hospital-acquired infections, which are dangerous for vulnerable individuals. The DNH order shifts the focus to providing comprehensive care within the current facility. This directive is a formal part of the patient’s medical record, communicating their wishes to all members of the care team. The order can be customized, allowing transfer only for specific conditions like a traumatic injury or a severe fracture that cannot be managed locally.
Differentiating DNH from Do Not Resuscitate
The Do Not Hospitalize order is frequently confused with a Do Not Resuscitate (DNR) order, but they address different aspects of medical intervention. A DNH order pertains to the location of care, directing the patient to remain in their long-term care setting rather than being moved to an acute care facility. The DNR order, by contrast, pertains to a specific intervention: cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
These two directives can coexist, as they govern different scenarios. A patient with a DNH order still receives all appropriate treatments within their facility, but the order prevents transfer for acute hospital care. A DNR order dictates that if the patient’s heart stops, CPR will not be attempted. The DNH focuses on avoiding the trauma of transfer, while the DNR focuses on refusing specific life-saving measures like chest compressions, intubation, and mechanical ventilation.
Care Provided Under a DNH Order
A DNH order does not mean a patient will be left untreated; instead, it refines the types of treatments provided to align with comfort-focused goals. The patient continues to receive comprehensive care for all medical conditions, emphasizing palliative and symptom management measures. For example, a patient with a DNH order who develops a respiratory infection can still receive oral or intravenous antibiotics, oxygen therapy, and medications to control fever and pain.
Care excluded under a DNH order includes aggressive, non-palliative treatments that necessitate an acute hospital setting, such as complex surgery, intensive care unit admission, or extensive diagnostic testing. The clinical team focuses on managing symptoms like pain, nausea, and shortness of breath in the current environment to maximize comfort. For patients with advanced illnesses, the burden of aggressive treatment often outweighs potential benefit.
The Process for Establishing or Changing a DNH Order
Establishing a Do Not Hospitalize order requires a formal process of informed consent and documentation. The order must be written and signed by a physician or authorized healthcare provider after a detailed discussion with the patient or their legally authorized decision-maker, such as a healthcare proxy. This discussion covers the patient’s prognosis, the goals of care, and the specific implications of the DNH directive.
Patients or their surrogates must understand that the order reflects a decision to manage a medical decline in the current setting, even if the condition is life-threatening. The DNH order is voluntary and revocable. The patient or their authorized agent retains the right to review, modify, or revoke the DNH order at any time if preferences or medical condition changes.