P3.I172: Improving Physician Follow-up After Infant Death in the Neonatal Intensive Care Unit

Purpose/Objectives: This is a quality improvement (QI) project aimed at improving the rate of attending physician documented follow-up with families after NICU death from 20% to 40% by December 2024. In so doing, we hope to improve family support by providers who played an integral role in their infant’s life and death.

Design/Methods: The primary drivers of this QI project are the standardization of protocols and guidelines regarding physician bereavement follow-up, education and awareness of the importance and benefit of family follow-up after a patient’s death, ensuring a family-centered approach, and developing resources to aid in follow-up practices and documentation. We first surveyed neonatology faculty at our institution and gained insight into the current bereavement communication practices in the division. Our institutional NICU QI microsystems team are advising on the development of guidelines for physician-led bereavement communication. These guidelines will be vetted by our NICU faculty at a divisional QI conference. The dissemination of unit standards will involve several iterations of staff education, the integration of specific elements and documentation in the EMR, and the creation of a job aid to facilitate its use. Adherence to guidelines will be measured after rollout of guidelines and documentation by a review of deceased patient charts. This QI project does not require IRB oversight.

Results: The faculty survey had a 63%(n=26) response rate. Only 12% (n=3) of respondents report “always” contacting the family after a patient’s death. Most respondents reported their contact was only “sometimes” (35%) and 30% admitted to “rarely” or “never” contacting the family. Further questions were grouped by whether the family requested an autopsy—in which case the physician was obligated to contact the family after the patient’s death within a given time frame—or not. More than half of all respondents reported contacting the family at least once regardless of autopsy status (n=15, 58%; n=15, 58%). Only 4% (n=1) reported not contacting the family at all when an autopsy was requested, while 35% (n=9) admitted to never contacting the family when an autopsy was not requested. The most cited barriers to contacting the family after death were “I do not want to re-traumatize the family by contacting them” (19.5%), “I did not know the patient very well” (17.5%), and “No expectation to follow-up” (17.5%).

Conclusion/Discussion: Current faculty practices reported through the survey appear to align with the documentation available through chart review. This QI project is ongoing.