Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Title

Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Creator

Trowbridge A; Bamat T; Griffis H; McConathey E; Feudtner C; Walter J K

Publisher

Academic pediatrics.

Date

2019

Subject

death; article; child; female; human; major clinical study; male; palliative therapy; retrospective study; controlled study; terminal care; resuscitation; education; medical record review; statistics; burnout; drug withdrawal; Burnout; End-of-Life Care; life sustaining treatment; Palliative Care; postgraduate student; resident; Resident Education

Description

OBJECTIVES: Pediatric residents are expected to be competent in end of life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures. METHOD(S): Retrospective chart review of all deceased patients at one children's hospital over three years collected patient demographics, time and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented. RESULT(S): Of 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths) however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of life-sustaining therapy (41%), followed by non-escalation (31%) and failed resuscitation (15%). During their post-graduate year (PGY)-1, <1% of residents encountered a patient death. During PGY-2 and PGY-3, 96% and 78%, respectively, of residents encountered at least one death. During PGY-2, residents encountered a mean of 3.5 patient deaths (range 0-12); during PGY-3, residents encountered a mean of 1.4 deaths (range 0-5). Residents observed for their full 3-year residency encountered a mean of 5.6 deaths (range 2-10). CONCLUSION(S): Pediatric residents have limited but variable exposure to EOL care, with most exposures in the ICU after withdrawal of life-sustaining technology. Educators should consider how to optimize EOL education with limited clinical exposure, and design resident support and education with these variable exposures in mind. Copyright © 2019. Published by Elsevier Inc.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

October 2019 List

Collection

Citation

Trowbridge A; Bamat T; Griffis H; McConathey E; Feudtner C; Walter J K, “Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital,” Pediatric Palliative Care Library, accessed March 29, 2024, https://pedpalascnetlibrary.omeka.net/items/show/16524.