Analyzing the day after a death in the NICU educates and heals .

Children's Hospital of Philadelphia



NEW YORK (Reuters Health) – "Rounding up" a patient from the neonatal intensive care unit (NICU) the day after death helps not only educate but also heal staff members, according to two teams that do routinely
"Short routine reports can help the entire team deal with the emotionally charged work we do in critical care," Dr. Wynne Ellen Morrison of the Children's Hospital of Philadelphia and the Perelman School of Medicine told Reuters Health. , University of Pennsylvania, in Philadelphia. email.

Dr. Morrison and Dr. Vanessa Madrigal of Children & # 39; s National Health Systems, in Washington, DC, and their ICU teams routinely report the death of a patient at the beginning of rounds of patient care the next day, They write in an article on Perspectives in Pediatrics.
These discussions serve to educate the entire team about how medical decisions were made, how death is declared, when organ donation is possible or appropriate, and how to talk to families facing the end of their children's lives.

The occasion also serves as a ritual that allows team members to remember the patient and pause to reflect on the human implications of the end of any life and share a lasting memory of the family or the child.

It also gives health care providers the opportunity to recognize their own emotions and to model coping skills for students so that they can provide more skilled and compassionate support to future patients and families in similar circumstances.
Dr. Morrison and Dr. Madrigal believe that the next day interrogation offers advantages over immediate interrogation or interrogations that occur days or weeks later, including the ability to involve many team members who took care of the patient before death. , providing a distance from the chaos that often surrounds the hours after death, but close enough that the emotions and questions are still fresh, and take advantage of the relative calm and active approach that accompany effective rounding.
"The main driver of being able to keep this kind of rounds or briefings as a routine part of our day is if team members find them valuable," said Dr. Morrison. "If a doctor in training has previous experience in the discussions and found it useful in the past, that doctor will help us remember to have the discussion the next time a patient dies."

"It definitely also helps to make it really a routine: having a bit of discussion, even if it seems to be a fairly simple event for the most important team members, often discovers previously unrecognized teaching points or areas of distress," he said. .
"The biggest challenge is always time," said Dr. Morrison. "When there are pressing clinical problems for active patients, the team may feel pressured to reach them. But taking a few minutes is a great long-term investment in team learning and health, and it's worth it. The time factor is one reason we have tried to start rounds with these discussions, avoiding the problem that everyone is distracted, tired and thrown in different directions at the end of the rounds. "
"Don't forget to be multidisciplinary whenever you can!" she added. "The care of patients in the ICU requires the contribution of so many different team members, and the results of the patients can affect them all."
Megan C. Quinn, a doctor and registered nurse at the Cardon Children's Medical Center, Banner Health Network's Neonatal Intensive Care Unit, in Mesa, Arizona, which has investigated various aspects of NICU care, told Reuters Health by email: "There are many The lip service paid to conduct an interrogation after a code or the death of a patient, but my experiences as both a NICU family nurse and a neonatal palliative care researcher are that this type of interrogation is rare ".

"A primary method of dealing with the death of a patient is to talk with colleagues, share stories about what happened, share fears and emotions, and create a personal account of the person's life and death," he said. "The report as described in the article allows colleagues to meet and create a shared narrative, providing additional details or perspectives to build a general image and providing space for all team members to feel their emotional experience validated by others who they shared the experience. "

"Interrogation rounds are an excellent practice that provides the opportunity to consciously reflect on a lost life, develop team cohesion and potentially mitigate moral distress among staff who often wonder if they did their best," said Dr Quinn, who did not participate in the new article. "But they will not happen by accident: intentional training and the constant implementation of bereavement rounding is essential to ensure that the practice becomes a tradition in the culture of unity."

"Physicians should partner with auxiliary and nursing staff members equally passionate about this type of practice to ensure that team members in all roles feel empowered to develop and own the practice," he said. "This is a way to return humanity to medicine that we should not ignore."

SOURCE: Pediatrics, online February 6, 2020.