Sudden death in the ed: Educating residents to compassionately inform families

doi:10.1016/0736-4679(92)90155-M

The Journal of Emergency Medicine

Volume 10, Issue 5, September–October 1992, Pages 643-647

https://doi.org/10.1016/0736-4679(92)90155-M Get rights and content

Abstract

We describe a program used in our emergency medicine residency to help teach residents new skills in interacting with survivors following a patient's sudden death in the emergency department. This teaching module requires about two and a half hours to complete. It includes a brief presentation of new skills, videotapes of family notification, resident role play experiences, and a summary. Trained volunteers are used as simulated survivors in the role plays. Although labor intensive and time consuming, the program offers educational advantages. The residents have an opportunity to practice their communication skills in a protected setting. In addition, they receive immediate and specific feedback from the faculty facilitator, fellow residents, and, most importantly, the simulated survivor. Following the role play sessions, residents feel they are more skillful in meeting survivors' needs.

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Application of the core competencies after unexpected patient death: Consolation of the grieved
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Citation Excerpt :
What should a surgeon do and say? Published guidelines for delivering adverse diagnoses/prognoses8,9 or informing family members of a trauma victim's demise during evaluation in an emergency room,10 are informative. Guidelines for delivering catastrophic news of an unexpected intraoperative patient death have also been published.11
To review and assess educational strategies and formats regarding communication with families/survivors in the aftermath of unexpected and untimely patient death. To propose an integrated curriculum designed and intended to foster proficiency, competence, confidence, and composure in relaying catastrophic information in the context of the professional experience of a cohort of seasoned surgeons.
Unexpected and untimely patient death is emotionally and psychologically wrenching for families, surgeons, and healthcare providers. We have previously proffered that 2 distinct, but interactive, phases of response are relevant when communicating with a family before and after the event: a proactive phase intended to establish a positive therapeutic relationship with the family; and a reactive phase intended to respond to the family in a compassionate and respectful manner and to ensure self-care for the physicians and health care providers.
Survey of a cohort of senior surgeons (membership of the Southern Surgical Association) and Surgical Residency Program Directors (membership of the Association of Program Directors in Surgery).
Sixty percent of the senior surgeons surveyed had experienced unexpected patient death. They advised strategies to cope with that clinical situation commensurate with the core competencies of the Accreditation Council for Graduate Medical Education: Medical Knowledge: maximize objective information/data and minimize subjective opinion; Patient Care: critique the events and conduct postmortem analyses; Interpersonal and Communication Skills: honesty, empathy, and patience; Professionalism: provide emotional and psychological support to family and personnel with privacy and in a nonaccusatory manner; Practice-Based Learning and Improvement: preoperative discussion and documentation in the context of informed consent and advanced directives vis-á-vis risk-benefit, effort-yield, and benefit-burden analyses; and Systems-Based Practice: involve chaplains and hospital personnel. Thirty-six percent of the graduate surgical educational programs surveyed allegedly provided educational venues to enable surgical residents to cope with unexpected patient death, although the formats were not specified.
Graduate, postgraduate, and continuing educational programs aspire to prepare physicians and surgeons for independent professional practice—scientifically, humanistically, and artistically. Incorporating educational strategies to enable graduates to cope with the emotional and psychological turmoil of unexpected patient death is relevant.
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2006, Academic Emergency Medicine
Citation Excerpt :
Other risk factors include past occurrences of other traumatic events, extreme and prolonged hyperarousal during the trauma, dissociative symptoms at the time of the trauma, the presence of an anxiety disorder, and female gender.18 Our observations and a few published reports indicate possible inadequacies in current methods of death disclosure in EDs and coronary care units and in services provided to survivors of sudden cardiac death victims.23–27 Poorly delivered disclosures of trauma death may have long-term negative effects on survivors.27
More than 300,000 sudden coronary deaths occur annually in the United States, despite declining cardiovascular death rates. In 2000, deaths from heart disease left an estimated 190,156 new widows and 68,493 new widowers. A major unanswered question for emergency providers is whether the immediate care of the loved ones left behind by the deceased should be a therapeutic task for the staff of the emergency department in the aftermath of a fatal cardiac arrest. Based on a review of the literature, the authors suggest that more research is needed to answer this question, to assess the current immediate needs and care of survivors, and to find ways to improve care of the surviving family of unexpected cardiac death victims. This would include improving quality of death disclosure, improving care for relatives during cardiopulmonary resuscitation of their family member, and improved methods of referral for services for prevention of psychological and cardiovascular morbidity during bereavement.
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Sudden death in the ed: Educating residents to compassionately inform families

Abstract

Ann Emerg Med

Informing the family of sudden death

Am Fam Physician

Sudden death in the emergency department: a com prehensive approach to families, emergency medical technicians and emergency department staff

Crit Care Med

Predictors and correlates of adaption to conjugal bereavement

Am J Psychiatry

On sudden death

Psychiatry

Bereavement

Br J Psychiatry

Bereavement: studies of grief in adult life

Emergency physicians' responses to families following a patient death

Ann Emerg Med

Sudden death: survivors' perceptions of their emergency department experience

J Emerg Nurs