Death of a Child in the Emergency Department

O’Malley, Patricia J.; Shook, Joan E.; Ackerman, Alice D.; Chun, Thomas H.; Conners, Gregory P.; Dudley, Nanette C.; Fuchs, Susan; Gorelick, Marc H.; Lane, Natalie; Moore, Brian R.; Wright, Joseph L.; Benjamin, Lee S.; Barata, Isabel A.; Alade, Kiyetta; Arms, Joseph; Avarello, Jahn T.; Baldwin, Steven; Brown, Kathleen M.; Cantor, Richard M.; Cohen, Ariel; Dietrich, Ann; Eakin, Paul J.; Gausche‐Hill, Marianne; Gerardi, Michael; Graham, Charles J.; Holtzman, Doug K.; Hom, Jeffrey; Ishimine, Paul; Jinivizian, Hasmig; Joseph, Madeline; Mehta, Sanjay; Ojo, Aderonke; Paul, Audrey; Pauze, Denis R.; Pearson, Nadia M.; Rosen, Brett; Russell, W. Scott; Saidinejad, Mohsen; Sloas, Harold A.; Schwartz, Gerald R.; Swenson, Orel; Valente, Jonathan H.; Waseem, Muhammad; Whiteman, Paula J.; Woolridge, Dale; Snow, Sally K.; Vicioso, Michael; Nagle, Jason; Renaker, Anne M.; Tomoyasu, Flora; Cadwell, Sue M.; Herrin, Shari A.; Brecher, Deena

doi:10.1542/peds.2014-1246

Cited by 38 publications

(22 citation statements)

References 66 publications

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“…While a vital part of medical practice, DBN compassionately is not a part of many training curricula [ 3 ], and there is evidence that bad news is frequently delivered inadequately, according to parents of pediatric patients [ 4 ]. In Pediatric Emergency Medicine (PEM), physicians are particularly challenged by DBN as they are charged with establishing a compassionate relationship with a family that they likely have not met before the medical crisis and there is little opportunity to prepare for the event [ 5 - 6 ]. A joint statement by the American Academy of Pediatrics and American College of Emergency Physicians stated, “The death of a child in the emergency department is an event with emotional, cultural, procedural, and legal challenges that often distinguish it from other deaths” [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows

Chumpitazi¹,

Rees²,

Chumpitazi³

et al. 2016

Cureus

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Background Bad news in the context of health care has been broadly defined as significant information that negatively alters people’s perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program’s objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent’s reaction to such news.MethodsPEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient’s parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected. ResultsBaseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows’ self-reported comfort level in DBN to a patient/family and dealing with patient and parent emotions improved significantly (p=0.034 and p=0.046, respectively).ConclusionsPediatric emergency medicine fellows frequently deliver bad news. A course using SPs was well received by trainees and resulted in improvement in self-assessed skills and comfort. This curriculum provides the opportunity for fellows to receive patient/parent feedback of their communication skills and observations from skilled instructors. This methodology should be considered when creating training curricula for bad news delivery skills.

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Section: Introductionmentioning

confidence: 99%

Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows

Chumpitazi¹,

Rees²,

Chumpitazi³

et al. 2016

Cureus

View full text Add to dashboard Cite

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“…The interview guide (Appendix 1) incorporated a combination of concepts drawn from literature [2,3,7,8,[12][13][14][15][16][17][18] and a modified Delphi method [19]. Criteria for termination were not explored in the 2009 review article by Topjian et al [20] or in the joint technical report by the American Academy of Pediatrics and the American College of Emergency Physicians [21]. However, factors that may be considered when terminating resuscitation found in the literature included age, prognosis, futility, quality of life, parental presence, child abuse, cost to the health care system, fear of litigation, and organ donation [2,3,5,[12][13][14][15][16][17][18][22][23][24].…”

Section: Interview Guidementioning

confidence: 99%

Factors influencing termination of resuscitation in children: a qualitative analysis

2020

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Background: Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians' attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital "non-medical" considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians. Methods: A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children's hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors. Results: Coding yielded 5 broad categories of "non-medical" factors that influenced physicians' decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept. Conclusion: Physicians consider numerous "non-medical" factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations.

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“…Of the most thorough, the American Academy of Pediatrics published a review for pediatric death in the emergency department. 1 They provide guidance on several essential aspects of post-death care including organ donation, autopsy, family bereavement, and care for the care provider. To support this need, we propose "Sunset Rounds" as a concise framework to address post-death issues (Table 1).…”

Section: Sunset Roundsmentioning

confidence: 99%