Wills, Trusts & Probate
That's All We Do
Comprehensive Guide to Do Not Intubate Orders
Navigating medical directives such as Do Not Intubate (DNI) orders requires clear information and careful planning, especially for residents of Temple City, California. A DNI order specifically communicates a patient’s wish to decline intubation in critical medical situations, helping prevent unwanted invasive airway procedures. Properly prepared documents reduce uncertainty for family members and medical staff and ensure that your preferences are respected by local healthcare providers. At LA Estate Plans, we provide guidance focused on creating DNI orders that align with your values and comply with state requirements, helping you make informed choices about life-sustaining interventions and emergency care directions.
Establishing a Do Not Intubate order is part of a broader approach to advance healthcare planning and estate planning, and it should be integrated with other important documents like advance healthcare directives and healthcare powers of attorney. Taking time to document your wishes and share them with loved ones and physicians helps avoid confusion during emergencies. Our team at LA Estate Plans assists Temple City residents with each step of the process, from discussing preferences to preparing clear, legally recognized forms and distributing copies to the right medical providers, ensuring your healthcare choices are accessible when they matter most.
Why DNI Orders Matter for Your Medical Preferences
A properly executed Do Not Intubate order provides a direct instruction to medical personnel to refrain from intubation, protecting a patient’s autonomy over respiratory care during life-threatening events. Having this directive documented lessens the burden on family members who might otherwise face difficult decisions under stress. It promotes consistency in care by giving healthcare teams clear guidance and can prevent interventions that do not align with a patient’s values. For Temple City residents, ensuring these orders meet California legal standards and are available to treating providers increases the likelihood that treatment will follow the patient’s documented wishes, offering comfort and clarity during emergencies.
About LA Estate Plans and Our Local Commitment
LA Estate Plans serves Temple City with focused support for estate planning and medical directives, including Do Not Intubate orders. Our practice emphasizes personalized attention and clear communication, helping clients understand their options and the California requirements that govern medical directives. We assist in preparing documents that reflect individual goals and in coordinating those instructions with other estate planning elements. Clients rely on our guidance to ensure documents are properly prepared, witnessed, and shared with healthcare providers so that their medical wishes are known and can be respected when decisions must be made quickly.
Understanding Do Not Intubate Orders in Temple City
A Do Not Intubate order is a targeted part of advance care planning that specifically directs clinicians not to place a breathing tube for airway management in an emergency or critical care setting. This directive is distinct from broader advance healthcare documents but can be used alongside them to create a full picture of your preferences. In Temple City, it is important to ensure the DNI order follows California procedures so medical staff recognize and honor it. Discussing options with family, your primary physician, and a legal advisor helps ensure your wishes are clearly communicated and documented for use in urgent clinical situations.
Creating a DNI order involves considering medical circumstances under which you would decline intubation and ensuring your statement is precise, accessible, and legally valid. The process typically includes selecting the appropriate form, detailing your preferences in plain language, and arranging for any required signatures or witnesses. Sharing the document with healthcare providers and designated decision-makers will improve the likelihood that your wishes are followed. LA Estate Plans helps Temple City residents prepare DNI orders in harmony with other directives and supports the distribution of copies to the relevant medical personnel and family members.
What a Do Not Intubate Order Means
A Do Not Intubate order communicates a patient’s specific decision to decline intubation, which is the placement of a tube into the airway to assist breathing. This written instruction guides emergency and hospital staff not to perform intubation even if breathing support is required, aligning treatment with the patient’s wishes. It is generally part of advance healthcare planning and should be clear, unambiguous, and accessible to caregivers. Properly prepared DNI orders reduce the risk of unwanted interventions and support the dignity of the patient by ensuring their preferences guide respiratory treatment choices during critical events.
Key Components and Steps for Valid DNI Orders
To create a valid Do Not Intubate order, certain elements should be present: a clear declaration of the intent to decline intubation, identification details for the patient, and appropriate signatures or witness statements as required by California law. The process often includes discussion with healthcare providers, selection of the correct forms, drafting precise language, and ensuring the document is distributed to medical facilities and proxies. Reviewing the order periodically and updating it after major health or personal changes helps keep the directive current and enforceable when needed in an emergency.
Key Terms and Definitions for DNI Orders
Understanding the specialized terms associated with DNI orders helps you make well-informed choices. Common entries include advance healthcare directives, intubation, DNI orders themselves, and durable powers of attorney for healthcare. Each term defines a different piece of advance planning, from general wishes about treatment to specific instructions for breathing support and the appointment of surrogate decision-makers. Familiarity with these concepts will help you assemble a coordinated set of documents that reflect your care preferences and are clear to medical teams and family members in Temple City hospitals and care settings.
Advance Healthcare Directive
An advance healthcare directive is a legal document that records a person’s treatment preferences and may designate who will make healthcare choices if the person cannot speak for themselves. It typically covers a range of decisions, including life-sustaining care, resuscitation, and preferences for comfort-focused treatment. In California, an advance healthcare directive should be written clearly and distributed to the patient’s medical providers and designated decision-makers. This document works in concert with specific orders like a Do Not Intubate instruction to provide comprehensive direction to healthcare teams about the patient’s wishes.
Do Not Intubate (DNI) Order
A Do Not Intubate order is a specific medical directive instructing healthcare providers not to perform intubation to assist breathing. It is a focused instruction that can be documented independently or as part of broader advance care planning. For it to be effective, the DNI order should be clear, signed according to applicable rules, and accessible to emergency and hospital staff. Ensuring the document is shared with physicians, facilities, and your designated decision-maker helps ensure that your wishes regarding intubation are followed in critical medical situations.
Intubation
Intubation is a medical procedure in which a tube is inserted into a person’s airway to assist or control breathing, commonly used in emergency and intensive care settings. This intervention can be lifesaving but may be unwanted by individuals who prefer less invasive treatment or who prioritize comfort-focused care. A Do Not Intubate order specifically directs medical staff not to use this procedure. Understanding the nature and implications of intubation can help patients articulate their preferences clearly when preparing advance directives and related medical orders.
Durable Power of Attorney for Healthcare
A durable power of attorney for healthcare is a legal document that appoints a person to make medical decisions on behalf of someone who cannot do so themselves. This designated decision-maker can interpret the patient’s wishes and communicate with healthcare providers when urgent choices arise. Combining a durable power of attorney with explicit directives like a DNI order ensures both the decision-maker and medical staff understand the patient’s instructions. Regular communication and providing copies to the appointed agent and medical teams increases the likelihood that care will reflect the patient’s preferences.
Comparing Legal Options for Medical Directives
When planning for medical care preferences in Temple City, individuals can consider standalone DNI orders, Do Not Resuscitate orders, and broader advance healthcare directives. Each option describes different interventions and levels of detail: DNI focuses solely on intubation, DNR targets resuscitation measures, and an advance directive can outline overall treatment goals and appoint decision-makers. Choosing among these depends on personal values, health conditions, and how much guidance you want to provide to clinicians and family. Coordinating these documents ensures consistent guidance across settings and clarifies how medical staff should respond in emergencies.
When a Limited DNI-Focused Directive Is Appropriate:
A Clear Preference Against Intubation
A limited approach focused on a Do Not Intubate order is appropriate when a person’s primary concern is avoiding intubation while remaining open to other treatments. Some individuals want to decline invasive airway procedures but still accept other forms of support or interventions. In those situations, a concise DNI order communicates that specific preference directly to medical personnel, reducing ambiguity. It should be paired with conversations among family members and treating physicians to ensure everyone understands the scope of the directive and how it fits with broader care goals.
Simplicity in Expressing Specific Medical Wishes
Simplicity can be advantageous when a person prefers a short, explicit instruction about intubation without creating a complex set of directives. A well-drafted DNI order gives a succinct statement that is easy for first responders and hospital staff to recognize and follow in an emergency. Keeping the language clear and ensuring the document is immediately accessible to caregivers and family members increases the chance it will be honored. Periodic review will keep the directive aligned with evolving health circumstances and personal preferences.
Why a Comprehensive Medical Directive Package May Be Beneficial:
Ensuring All Treatment Preferences Are Addressed
A comprehensive approach to medical directives is useful when you want to address a range of potential interventions beyond intubation, such as resuscitation, mechanical ventilation, and overall goals of care. Having an advance healthcare directive, a durable power of attorney for healthcare, and specific orders like a DNI or DNR provides multiple layers of instruction to clinicians and delegates decision-making authority in line with your values. This coordination reduces confusion and helps families and providers make consistent choices that reflect your documented wishes across different care settings.
Legal Validity and Clear Communication to Providers
Comprehensive legal support helps confirm that your directives meet California requirements for validity and are communicated to the proper medical contacts. Ensuring proper signing, witnessing, and distribution to healthcare providers increases the likelihood that your instructions will be followed in emergency circumstances. Legal guidance can also help reconcile your DNI order with other estate planning documents so there are no conflicting instructions, which helps clinicians and family members honor your choices consistently during stressful events.
Benefits of Taking a Comprehensive Medical Directive Approach
A comprehensive planning strategy reduces uncertainty during medical crises by documenting a full set of preferences and appointing a decision-maker who understands your values. This combination helps avoid disputes among family members and provides medical staff with reliable instructions, which can prevent interventions that conflict with your priorities. For Temple City residents, aligning DNI orders with other directives and ensuring their accessibility at hospitals and primary care offices promotes consistent treatment aligned with personal goals and legal expectations.
Comprehensive planning also eases emotional burdens on loved ones who might otherwise be tasked with making difficult choices without guidance. Clear written directions and an authorized healthcare agent give family members confidence that decisions reflect the patient’s intent. In addition, well-documented directives can facilitate communication with multiple providers and care facilities, ensuring that transitions of care do not lead to unintended procedures. Regularly reviewing and updating documents keeps the plan current as health or personal circumstances change.
Peace of Mind for You and Your Family
Knowing that your treatment preferences are recorded and shared with the right people brings reassurance to you and your loved ones. This documented clarity reduces the likelihood of disputes and makes it simpler for family members to support your medical wishes if you cannot speak for yourself. For those in Temple City, keeping directives accessible at local medical facilities and with designated decision-makers increases the chance your stated preferences will guide care and reduces stress during emergency medical events.
Clear Guidance for Healthcare Providers
Providing explicit instructions through a coordinated set of documents helps healthcare teams act in line with your values and treatment goals. Clear directives reduce ambiguity and guide clinicians when rapid decisions are required. Sharing the DNI order with your treating physicians, hospitals, and designated decision-maker ensures teams are prepared to follow your instructions. This clarity helps maintain dignity in care and reduces the chance of interventions that you would have declined, creating a smoother experience for both patients and medical staff.
Practice Areas
Top Searched Keywords
- DNI order Temple City
- Do Not Intubate California
- advance healthcare directive Los Angeles County
- durable power of attorney healthcare Temple City
- DNR vs DNI differences
- medical directives LA Estate Plans
- end of life planning Temple City
- how to create DNI order California
- healthcare proxy Temple City
Practical Tips for Planning Your DNI Order
Discuss Your Wishes Early and Clearly
Begin conversations about your desires for intubation and other life-sustaining treatments with family members and medical providers well before a crisis. Open discussion reduces misunderstandings and helps your designated decision-maker understand the reasoning behind your choices. Recording those conversations in a written DNI order and sharing copies with your physicians and loved ones ensures your directives are more likely to be followed when time is limited. Periodic conversations also make it easier to update documents as health or personal preferences evolve.
Regularly Review and Update Your Documents
Keep Your Documents Accessible to Providers
Ensuring that your DNI order and other directives are readily accessible to medical personnel increases the chances they will be honored in emergencies. Provide copies to your primary care physician, any specialists, and the hospitals and clinics where you receive care. Also give copies to the person you have appointed to make healthcare decisions on your behalf. Storing copies in a known and reachable location and considering electronic storage options used by healthcare systems can further improve timely access to your instructions.
Reasons to Establish a DNI Order
There are several reasons an individual might choose a Do Not Intubate order: a desire to avoid invasive airway procedures, plans to prioritize comfort-focused care, or existing medical conditions that make intubation unlikely to improve quality of life. Formalizing this preference through a written directive reduces uncertainty for family members and clinicians, ensuring that emergency care aligns with your values. Properly executed DNI orders and accompanying documents help avoid confusion and support dignified, coordinated medical care that reflects your stated intentions.
Another reason to prepare a DNI order is to provide decisive guidance during moments when communication is impossible. Without written instructions, family members may face agonizing choices without clear direction. A DNI order clarifies what you would prefer and relieves loved ones from making speculative decisions under emotional strain. In Temple City, sharing these orders with local doctors and hospitals and ensuring legally sufficient execution increases the likelihood that your instructions will be available and respected in urgent circumstances.
Common Situations Where People Choose DNI Orders
People commonly establish DNI orders when living with progressive or terminal illnesses, when advanced age makes invasive procedures less desirable, or when strongly held personal beliefs oppose intubation. Others choose DNI orders as part of wider end-of-life planning to ensure specific interventions are declined while leaving other care options open. Discussing likely scenarios with your physician and documenting preferences in writing helps tailor the directive to anticipated circumstances so medical teams clearly understand when to refrain from intubation.
Chronic or Terminal Illness Planning
For individuals with chronic or terminal conditions, a DNI order can help guide clinicians toward treatments that focus on comfort and quality of life rather than invasive airway interventions. This written instruction clarifies the patient’s priorities and reduces the chance of procedures that may not align with care goals. Including a DNI order as part of a broader plan ensures that both medical teams and family members understand and can honor the patient’s preferences in situations where rapid treatment decisions are needed.
Planning During Older Age
Older adults often include DNI orders among their advance directives to make preferences about breathing support clear well in advance of emergencies. Aging can bring multiple medical considerations, and recording specific wishes about intubation relieves family members from guessing what the patient would have wanted. Sharing the DNI order with physicians and the appointed healthcare decision-maker helps the medical team apply those preferences consistently across different care settings and emergency situations.
Personal Treatment Preferences
Some people have firm preferences regarding invasive interventions based on personal, cultural, or medical reasons and use a DNI order to ensure those preferences are followed. A DNI order is a focused way to communicate the wish to decline intubation while leaving other treatment choices flexible. Providing clear instructions and ensuring your decision-maker and medical providers are aware of the order helps guarantee that your treatment aligns with your values, even in high-pressure clinical moments.
We Are Here to Assist with Your DNI Order
Why Choose LA Estate Plans for DNI Orders
Choosing a legal team to assist with DNI orders can help ensure documents are properly drafted and executed according to California rules, reducing the risk of accidental invalidity or misinterpretation. We provide detailed attention to drafting language that communicates your wishes plainly and to coordinating distribution to hospitals and designated decision-makers. Our approach focuses on practical steps that improve the likelihood your instructions will be honored, offering you and your family clarity and protection during medical crises.
Our process includes discussing specific scenarios, reviewing current medical documents, and advising on how a DNI order interacts with other directives like advance healthcare directives and powers of attorney for healthcare. We work to ensure all documents are consistent and accessible to the right parties. Clear communication and careful document management help prevent misunderstandings and support seamless decision-making by medical teams and your appointed surrogate when urgent choices arise.
We also help clients plan for distribution and retention of documents so that copies reach primary care physicians, specialists, and facilities likely to treat you in an emergency. This practical assistance improves the probability that your DNI order will be found and followed when time is limited. Ongoing review and assistance make it easier to adapt directives in response to changes in health or personal preferences, ensuring your documents remain reflective of your current wishes.
Contact LA Estate Plans to Prepare Your DNI Order
Our Process for Preparing DNI Orders
Our process for preparing a Do Not Intubate order combines careful information gathering, clear drafting, review, execution, and distribution so the document can function as intended. We begin with an in-depth conversation about your wishes and medical context, then prepare a clear written directive and coordinate any signatures or witnesses required under California law. Finally, we assist in delivering copies to your medical providers and designated decision-maker to ensure your instructions are accessible in an emergency.
Step One: Initial Consultation and Information Gathering
The initial step involves discussing your health situation, values, and specific preferences regarding intubation and other treatments. We review any existing advance directives and identify any conflicts or gaps. This conversation helps determine the precise language needed to reflect your wishes and clarifies who should receive copies of the final documents. Understanding your intentions enables us to tailor the DNI order to your circumstances and to advise on how it fits with other planning documents.
Discussing Health Preferences and Goals
During the first part of the process, we explore your values regarding life-sustaining treatment and the outcomes you wish to avoid or pursue. This detailed discussion helps frame the scope of a DNI order and any related directives. We encourage clients to consider how different medical scenarios might influence their choices and to involve potential decision-makers in the conversation so everyone understands the intent behind the directive.
Reviewing Existing Documents and Medical Information
We examine any previously executed advance directives, powers of attorney, or medical orders to ensure consistency and identify updates needed for clarity. Reviewing medical records and consulting with your physicians when appropriate helps us draft language that is both precise and consistent with best practice. This step reduces the chance of conflicting instructions and ensures the final DNI order aligns with the broader plan for care.
Step Two: Drafting and Reviewing the DNI Order
In step two we prepare the written DNI order using clear, unambiguous language that expresses your direction to decline intubation. We tailor wording to match your preferences and to conform with California legal expectations. After drafting, we review the document with you to confirm that it accurately reflects your wishes and make any needed revisions. This collaborative review helps ensure both legal validity and practical clarity for emergency and hospital staff.
Drafting Clear and Actionable Language
Drafting focuses on statements that medical personnel can readily understand and apply in time-sensitive situations. We avoid ambiguous terms and ensure the directive identifies the patient and the document’s purpose clearly. The goal is to produce an instruction that health teams can locate and interpret without delay, thereby reducing the likelihood of unwanted intake of medical procedures during an emergency.
Client Review and Revisions
After preparing the draft, we review it with you to confirm that the language matches your intentions and to incorporate any adjustments. This collaborative stage gives you the opportunity to ask questions, refine specifics, and ensure that the directive will be interpreted as you intend. We also discuss who should receive copies and how to make the document available to medical providers and your appointed decision-maker.
Step Three: Execution and Distribution of the DNI Order
The final step includes signing the DNI order in the manner required by California law, arranging any necessary witness or notarization procedures, and distributing copies to relevant parties. We assist with the formal signing process and help ensure the document is shared with your primary physician, any specialists, and local hospitals or clinics where you receive care. Proper distribution increases the likelihood that emergency and hospital staff will find and follow the directive when needed.
Formal Signing and Witnessing Procedures
We guide you through the signing and witnessing requirements that apply in California to help preserve the document’s validity. This may include arranging witnesses or notarization where appropriate and verifying that all identification and signature elements are completed correctly. Proper execution removes common procedural obstacles that can lead to questions about a document’s enforceability in a clinical setting.
Sharing Copies with Providers and Decision-Makers
Once executed, the DNI order should be shared with medical providers, your designated healthcare agent, and family members so that it can be accessed quickly in emergencies. We assist in preparing and delivering these copies and recommend practical steps for storage and retrieval in urgent situations. Making sure that copies are in the right hands helps ensure the order has the intended effect when prompt medical action is required.
The Proof is in Our Performance
Frequently Asked Questions About Do Not Intubate Orders
What is a Do Not Intubate order and how does it work?
A Do Not Intubate order is a written medical instruction that tells healthcare professionals not to perform intubation to assist breathing. It is intended to be used in emergency and critical care settings and should be clearly written and accessible to medical staff. The instruction focuses specifically on declining the placement of an airway tube and can be used alone or alongside other advance care documents to communicate your treatment preferences to providers. Ensuring the order is properly prepared helps medical teams respond in a manner consistent with your wishes. To be effective, the DNI order should identify the patient, state the patient’s decision regarding intubation, and include any required signatures or witness statements under California rules. Share copies with your primary care physician, specialists, hospitals, and the person appointed to make healthcare decisions for you. Having multiple copies available and confirming that providers have received them increases the likelihood that the DNI order is located and honored when timely decisions are needed.
How do I create a valid DNI order in California?
Creating a valid DNI order in California typically involves completing the correct medical form or drafting a clear written statement that specifies the decision to decline intubation. The document should identify the patient and include signatures or witness acknowledgments as required by state law. It is important to use plain, direct language so medical staff can quickly interpret and apply the instruction. Ensuring the form follows applicable procedural rules reduces the chance of disputes or confusion during emergencies. After preparing the document, provide copies to your physicians, hospitals where you may receive care, and to the person you designate to make healthcare decisions for you. Consider keeping an accessible original in a secure but reachable location and updating the document if your health or preferences change. Periodic review helps maintain the document’s relevance and legal sufficiency over time.
Can I change or revoke my DNI order after it is signed?
Yes, you may change or revoke your Do Not Intubate order at any time as long as you have the capacity to make such decisions. Revocation should be clear and communicated to the same people and providers who received the original order to avoid confusion. It can be helpful to create a signed statement withdrawing the prior instruction and distributing copies to physicians, hospitals, and your appointed decision-maker so everyone is aware of the change. If you update your DNI order, it is important to retrieve and destroy outdated copies where possible and replace them with the new version. Notifying medical facilities and adding the revised document to your medical record helps ensure care teams follow your current wishes in emergency situations.
Who should I share my DNI order with to ensure it is followed?
Share your DNI order with your primary care physician, any specialists involved in regular care, and the hospitals or clinics where you might receive emergency treatment. Provide copies to the person you designated to make healthcare decisions on your behalf so they can advocate for your wishes. Ensuring these parties have copies increases the chances that the order will be located quickly during an emergency. Consider also informing close family members and storing a copy in a known location for quick retrieval. Some healthcare systems support uploading advance directives into electronic medical records; asking your provider about this option can further improve accessibility to your instructions.
What is the difference between a DNI order and a DNR order?
A DNI order directs clinicians not to perform intubation, which is the insertion of a tube into the airway to assist breathing. A Do Not Resuscitate order, or DNR, instructs providers not to perform cardiopulmonary resuscitation or advanced cardiac life support if the heart stops. Both are specific medical instructions but target different interventions, so it is important to understand which measures you wish to decline and to document those choices clearly. Because the orders address separate procedures, some people choose to have both a DNI and a DNR or include both preferences within a broader advance healthcare directive. Coordinating these choices helps clinicians understand the full scope of your treatment goals and act accordingly in various emergency scenarios.
Do I need legal help to prepare a DNI order?
While it is possible to complete state-approved forms on your own, legal guidance can be helpful to ensure the document is drafted and executed in a way that minimizes ambiguity and conforms with California requirements. Assistance can also help coordinate the DNI order with other directives like advance healthcare directives and powers of attorney for healthcare so there are no conflicting instructions. Legal support focuses on making the documents clear and practically useful for medical teams and decision-makers. If you choose to prepare documents independently, be diligent about clear language, proper signing and witnessing if required, and distribution to your medical providers and designated agent. Regularly review the documents and consult with a legal professional when you need updates or face unusual medical circumstances.
How will medical personnel know about my DNI order in an emergency?
Medical personnel may become aware of your DNI order if copies are included in your medical record, if treating physicians or clinics have received a copy, or if your designated healthcare agent provides the document at the time of care. Keeping the order with other medical documents and informing your providers during routine visits increases the chance it will be in the chart and accessible in emergencies. Some systems allow uploading advance directives electronically, which can aid in rapid discovery by emergency teams. Additionally, giving copies to family members and first responders when appropriate can help ensure the directive is presented quickly when needed. Clear communication and multiple accessible copies are practical steps to help medical staff find and follow your DNI order.
Will a DNI order prevent all emergency treatments?
A DNI order specifically addresses intubation and does not necessarily prevent all emergency medical treatments. Other interventions such as oxygen therapy, medications, or noninvasive breathing support may still be offered depending on your broader directives and the clinical situation. It’s important to specify any other preferences in an advance healthcare directive so medical teams understand the full scope of your wishes beyond intubation. If you wish to decline additional interventions beyond intubation, state those preferences clearly in your advance directives or discuss them with your healthcare provider and designated decision-maker. Coordinating documents ensures clinicians have a complete picture of the treatments you would or would not want.
How often should I review or update my DNI order?
Review your DNI order periodically and after significant changes in your health, relationships, or personal values. Regular review ensures that the document accurately reflects your current wishes and that it remains consistent with any new medical guidance. Updating the order also provides an opportunity to redistribute revised copies to providers and to confirm that your designated decision-maker is prepared to act according to the updated instructions. A routine check every year or after major life events is a practical approach to keeping your directives current. Ensuring proper execution and distribution of any updates helps maintain the document’s effectiveness in urgent clinical situations.
What if family members disagree with my DNI order during an emergency?
If family members disagree with a DNI order during an emergency, the written and properly executed directive should guide medical decisions when it is available and valid under California rules. Clear documentation and prior distribution to treating physicians reduce the likelihood of disputes. The appointed healthcare decision-maker should advocate for the patient’s documented wishes, helping clinicians follow the directive rather than relying solely on family consensus. If a conflict arises despite documentation, clinicians will typically follow the legally valid written instruction when it can be located and verified. Seeking timely legal or institutional assistance may be necessary in rare situations where disputes cannot be resolved quickly at the bedside.