The aim of this study is to gain insight in patients' experiences regarding do not resuscitate conversations and decisions. A multicentre flash mob investigation will be conducted in which data will be obtained over the course of two weeks using electronic questionnaires that patients will fill out. General demographic data and a brief quality of life assessment (EQ-5D) will be collected. Whether a DNR converstation has taken place will be noted, along with patients' experiences with this conversation. Lastly the patient will be asked about his/her expectations of survival after cardiopulmonary resuscitation.

Rationale: In-hospital cardiac arrest, associated with a survival to discharge of 15.0%, results in a good neurologic discharge in 9.1% - 30.0% of patients. Therefore it is recommended to engage in advanced care planning with patients, to discuss do-not-resuscitate (DNR) directives. In current knowledge, there are no published data about the prevalence of these DNR orders and associated factors in hospitalized patients in the Netherlands. Also, the conversation about DNR are sometimes perceived as awkward or untimely by patients.

Objective: The primary goal is to estimate prevalence DNR order in Dutch hospitals. A secondary goal is to assess what geographical, patient and disease factors are associated with DNR status. Furthermore patient experience in the conversation leading to DNR-orders is of interest.

Study design: A cross-sectional point prevalence study, in 10 participating hospitals of the ROUTiNE project.

Study population: Patients who plan to be admitted for more than 24 hours to the participating hospitals, aged 18 or older, who are responsive and conscious.

Main study parameters/endpoints: The prevalence of DNR orders, expressed as number per 1000 beds.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: There is no risk. Only one ten-minute interview per participant. Therefore the benefit of this study (as described in the objectives) outweigh the potential risks.

Inclusion Criteria:

• All patients admitted to the participating hospitals with a planned admission >24 hours at the moment this study takes place.

Exclusion Criteria:

• • Refusal to participate

  • <18 years of age

  • Admitted in outpatient clinic and day treatment centres (e.g. haemodialysis)

  • Admitted <24 hours, as defined by not sleeping overnight in hospital

  • No reliable proxy in the following situations:

    • Unable to answer questions (e.g. unconscious, cognitively impaired, delirious)
    • Language barrier (with no interpreter or family member)

  • The following hospital departments are excluded:

    • Intensive care unit
    • Coronary/acute cardiac care unit
    • Obstetrics
    • Paediatrics
    • Stroke unit
    • Dialysis (outpatient dialysis)
    • Day-care wards/short-stay (i.e. <1 day)
    • Palliative care

The base population consists of all adult patients admitted to all the participating hospitals. These consist of one academic centre and 10 general hospitals. The sampling is based on non-probability as it does not represent the entire population (i.e. inhabitants of the Netherlands), however it is based on probability sampling when the population is solely patients admitted to hospital.

Because of the personal nature of data (reg. age, sex, religion, eductional level) we will not make it available.