We Still Round the Next Day.

Abstract

The ICU team gathers for their morning rounds. One of their patients died the day before. The team members look at the room where the patient had been; perhaps it is empty, or perhaps it has already been filled with another patient and family. The day the patient died may have been filled with escalating therapies and vigorous resuscitation attempts that failed to save her, or perhaps the staff had been gently supporting a child and family through the night as technology was removed and comfort assured. For some on the team (maybe a student or resident) this could be the first patient they have cared for who died.1 For others (fellow, attending, ICU nurses), this may have become a more-common experience. Multiple team members may still be thinking about the events of the day before, remembering the patient or wondering about the outcome and why certain decisions were made. Our ICU teams have developed a practice of debriefing a patient death at the beginning of patient-care rounds the following day. In effect, we “round” on the patient for one final day after the death. The patient’s primary resident or nurse practitioner begins with a 1- to 2-sentence description of the patient and events of the previous day, and then the attending facilitates a group discussion. We typically spend <10 minutes in the discussion, before moving on to current patients and daily work of … Address correspondence to Wynne Morrison, MD, MBE, FCCM, Division of Critical Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 6 Wood, Philadelphia, PA 19104. E-mail: morrisonw{at}email.chop.edu