44: Emergency Physicians' Experiences With Patient Death

Abstract

There is a growing awareness of patient death on physician well-being and the importance of cultural and educational changes to improve coping mechanisms. The objective of this study is to explore both the impact of patient death on emergency physicians and the coping mechanisms they use to deal with these events. Faculty at four emergency medicine (EM) residency programs were questioned about their responses to patient death in a fifteen question on-line survey. Descriptive analysis of the data was performed. Of 207 emergency physicians surveyed, 145 (70%) responded. Patient death was experienced frequently with 95 (66%) witnessing a death at least every month. No training on coping with patient death had occurred for 24% (35); and 64% (93) had less than six hours of instruction. The most common coping mechanisms used included talking with colleagues (113; 78%), discussions with friends and family (100; 69%), and simply continuing to work (89; 61%). Post-death debriefing occurred rarely or never for 93 (64%) of respondents. Most emergency physicians had experienced physical response to patient death, the most common being insomnia (54; 37%) and fatigue (21; 14%). Common emotional responses included sadness (112; 70%) and disappointment (55; 38%). Patient death was reported to lead to both physical and emotional symptoms in emergency physicians. Post-death debriefing appears to happen infrequently in teaching settings and most emergency physicians report that they received limited training in coping with patient death. Further study is needed to both identify coping mechanisms that are feasible and effective in emergency department settings and develop teaching strategies to incorporate this information into EM residency training.