Handling deaths is a stressful but unfortunately common event for hospital‐based trainees. This experience is a key component of the practice of palliative care. Training in palliative care is a responsibility and a requirement of postgraduate medical education programs. Systems‐based improvements have the capacity to reinforce learned behaviors.
(1) To teach trainees key aspects of the process of declaring death, including communication techniques and (2) to create systems‐based improvements to ensure sensitive and proper handling of inpatient deaths.
The program consists of 4 parts, 2 educational interventions and 2 system improvements. An hourlong didactic session is given to interns in the beginning of their residency as part of a course on hospital emergencies. The content focuses on procedural and communication issues. Procedural issues include documenting the physical exam, completion of the death certificate, discussion of autopsy, and notification of the medical examiner and the organ procurement organization. Communication issues include discussions with families of patients after expected deaths, unexpected deaths, and over the telephone. Communication techniques are based on Buckman's 6‐step protocol for breaking bad news. The lecture was followed by a role‐play session. Two cases were created for the course. One involves an expected death; the other involves an unexpected death. Each session consists of 15 interns and is facilitated by a chief medical resident and a palliative care attending physician. The hospital's death packet was revised to minimize the paperwork required for physicians, nurses, and ward clerks. The packet was reviewed by key stakeholders including the leadership of critical care units, trauma units, nursing, admitting, and the morgue. A list of communication tips for care providers and a bereavement packet for next of kin were created to accompany this packet. All items were posted on the hospital's intranet for ease of access. A template for the death note was created in the electronic medical record. The template includes prompts for each of the key tasks in the death pronouncement procedure described in the didactic session. After piloting in the medical intensive care unit (ICU), revisions were made and finalized. The new procedures were announced at monthly orientation sessions for pediatric, general medicine, and medical ICU ward rotations. They were also presented to the heads of nursing and admissions.
Hospitalists who work with trainees are responsible for teaching residents the skills required to manage inpatient deaths. By reinforcing the impact of learning sessions with prompts built into the procedure, this intervention has the potential to enhance physician performance and improve patient satisfaction.
J. Baru ‐ none; C. Deamant ‐ none
To cite this abstract:Baru J, Deamant C. Teaching Death Pronouncement: Reinforcing Didactics with Systems‐Based Improvements. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 155. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/teaching-death-pronouncement-reinforcing-didactics-with-systemsbased-improvements/. Accessed March 31, 2020.