Abstract 179: Sanctifying Sadness: Conducting a Moment of Silence at Time of Patient’s Death is Associated With Decreased Staff Burnout

Abstract

Introduction: Anecdotal stories exist about pausing to honor resuscitation teams and the patient after in-hospital deaths. It is unknown whether conducting a moment of silence (MOS) at the time of death impacts caregivers. Objectives: We sought to assess whether implementing a scripted and brief, secular MOS ritual after a patient dies reduces healthcare team burnout or improves resiliency. Methods: We conducted an unblinded, prospective cohort study of multidisciplinary intensive care unit (ICU) staff from two hospitals, implementing the MOS in one ICU with the other a control. The Maslach Burnout Inventory (MBI) was administered pre- and post-implementation and focus groups obtained qualitative feedback. Changes in median composite scores were assessed for comparisons using the Wilcoxon Signed-Rank Test. Results: We obtained 25 pre-post paired responses. The implementation ICU’s respondents included more physicians (36.4% vs 0%, p=0.032) with no difference in other measured characteristics. MBI scores pre-implementation were similar. After implementation, intervention staff had a significant decrease in median Depersonalization subscore on the MBI (median: 8 vs 6; p=0.045). MBI Emotional Exhaustion subscore trended toward improvement (median: 26 vs 24; p=0.075) and the Personal Accomplishment subscore was unchanged (median: 37 vs 34; p=0.18). No significant changes over time in MBI scores were noted in the staff from the control ICU. Qualitative feedback was universally positive, resulting in dissemination of the MOS system-wide. Conclusion: Implementation of a brief, secular MOS ritual in a community hospital’s ICU was associated with decreased burnout, specifically in the Depersonalization domain. This may be due to the creation of a formalized, group time for clinicians, nurses and multidisciplinary staff to attend to their own emotions after a patient death. Rollout of the scripted MOS intervention across the 5-hospital system, including distinctive phraseology for the pediatric, peri-operative, and maternity settings, shows widespread buy-in including within health system leadership. Larger studies and those conducted in other healthcare settings would increase confidence in the generalizability of results.