P3.I175: Ready or Not? Critical Perspectives from Adult-Focused Emergency Medicine Clinicians on Managing Pediatric Deaths

Purpose/Objectives: Pediatric deaths represent less than 4% of total emergency department (ED) deaths, however, they are consistently rated as one of the most stressful events by ED clinicians (O’Malley, 2014, Pediatrics). Without adequate training and support, this can lead to adverse outcomes for both caregivers and providers.
Limited data exists on the perspectives of adult-focused ED clinicians managing pediatric deaths. This project aimed to collect these critical perspectives to help inform future interventions to close educational and institutional gaps.

Design/Methods: We developed an electronic survey that was distributed to adult-focused ED clinicians at 8 different EDs. Utilizing multiple-choice and Likert scale formats, questions focused on comfort, stress and institutional support following a pediatric ED death. This survey was validated by 5 independent healthcare professionals. Statistical analysis was performed using Excel and Prism. Correlation was obtained via Fisher’s exact test, with P values indicating the probability of the null hypothesis that the Spearman Coefficient is 0. IRB waiver was granted.

Results: 150 ED clinicians were contacted and 72 completed this survey (response rate: 48%): 49% adult-trained ED physicians, 14% PA/NPs, 24% RN.
85% described pediatric ED deaths as extremely stressful whereas 10% reported this for adult ED deaths. Respondents reported the least comfort in having caregivers present during resuscitation (53%) and communicating with caregivers (60%). 37% reported that their hospital does not have protocols/guidelines for pediatric ED deaths.
38% reported symptoms of grief at one year following the death. There was a positive correlation (p < 0.001) between those with grief counseling at their hospital and those reporting reduced symptoms of grief (OR 0.1, 95% CI [0.03-0.3]).
20% of respondents had received simulation training in the management of pediatric ED deaths. There was a significant (p < 0.04) association between prior training and greater comfort communicating with caregivers (OR 3.46 [95% CI 1.1-9.4]).
95% of respondents requested more training.

Conclusion/Discussion: This survey highlights pediatric ED deaths are highly stressful amongst adult-focused ED clinicians and there is a clear lack of training, protocols/guidelines and support for these deaths.
Respondents reported an overall lack of comfort, particularly with caregiver communication, suggesting the need for increased training.
There is a concerning lack of grief support for struggling clinicians, despite reports of prolonged grief following pediatric ED deaths. We report the presence of counseling correlates with a reduction in provider grief, suggesting the importance of institutional intervention.
The results of this survey reveal a significant population of adult-focused ED clinicians do not feel prepared or supported following the death of a pediatric patient. Future research includes disseminating this survey to other EDs to determine the scope of this problem and addressing the gap through increased educational and psychological interventions.