End of Life Care — Post-mortem Family Communication — Clinical Pathway: Emergency

End of Life Care Clinical Pathway — Emergency Department

Post-Mortem Family Communication

Physician
  • Attending physician should notify family
  • Inform family that Gift of Life may contact them for organ donation
  • Use a skilled interpreter/language line if needed to communicate
  • Use the word “death”—no euphemisms ("passed away")
  • Initiate conversation regarding autopsy when appropriate
RN
  • "Check-in" with family at minimum every 30 minutes
  • Consider additional resources (e.g. social work, chaplain) or more frequent support based on family needs
  • Continuous observation while family is present with the deceased is not routinely required
  • Review “Family Members” and “Forensic Cases” below for additional details and exceptions
Social Work
  • Assist physician in obtaining contact information (DOB, next of kin name/number)
  • Help contact additional family as requested
  • Assist with workplace bereavement leave
  • Assist family with funeral arrangements
  • Explain logistics of disposition to Medical Examiner or morgue
  • Offer bereavement materials through Evenstar
  • Collaborate with family, security, and others on crowd control
Child Life
  • Assist in keepsake process (handprints, pictures, locks of hair) with ME and family permission:
  • Engage parents to support present children using developmentally appropriate language
  • Engage present children in memory making
  • NOTE: The ME will allow keepsakes the majority of the time; if ME staff communicating with CHOP MD denies request, please confirm with the Medical Examiner on call
Family Members
  • Family Members For groups of family members, attempt to use family room
    • Can also use EDECU conference room, empty ED rooms, or Stokes Auditorium for large groups
  • Family members should rotate through rather than be present at once when possible
  • Security is a resource for crowd control
  • Providers should set an expectation with the family that the deceased will be moved (to the ME or the morgue) in 3 hours time
  • Give a gentle reminder to the family as this time period comes to a close
  • Please allow for extenuating circumstances that might favor a longer period of time in the ED
  • If a family is not ready to the leave the hospital but is ready for the deceased to be moved, please show them to the chapel or waiting areas around the Atrium.
  • This communication with the family may be through a nurse, a social worker, or the attending as determined by the team
Forensic Cases
  • Visitation, patients < 18 yrs
    • In certain forensic cases, where there is specific concern an adult would tamper with the body, consider continuous observation after discussion with social work/attending physician/nursing leadership
    • If active investigation (GSW, abuse, assault, NAT) seek guidance and collaborate with police, CPS, security and SW to coordinate visitation
    • Utilize “.edbereavement” phrase to capture family and staff present
  • Visitation, patient ≥ 18 yrs
    • Family member identities should be confirmed of those who present with patient
    • No additional visitors (Seek guidance from SW and Security)
    • If patient is a GSW, no visitors

Communication Tips

  • Self-reflection, acknowledge your own feelings
  • Strive to be a kind, steadying presence
  • Know and use the child’s name
  • Try to gather the right family members when possible
  • Use the Family room whenever possible, have tissues available
  • Sit down at eye level, turn off your phones
  • Introduce yourself, shake hands or touch family members
  • If family has not been present for resuscitation yet, determine what family understands about present situation
  • Use a warning shot – "I am sorry to give you this bad news…"
  • Sit quietly and allow them to respond when possible
  • Hear and respond at their pace; be prepared to repeat information
  • Reassure them that their child did not suffer
  • Alleviate guilt as families assume that they could have prevented the death
  • Offer assistance in the sharing of this news to other family members
  • Can describe next steps, including notification of Primary Care Provider and relevant Subspecialists
  • Provide names and contact information for care providers (MD, SW)

AAP Technical Report, Death of a Child in an Emergency Department, July, 2014