Pediatric Death in the Emergency Department

OBJECTIVE: To explore pediatric emergency medicine (PEM) physician perspectives on the death of a child in the emergency department (ED) to identify key lessons learned and areas for improvement in care and provider support. METHODS: We conducted a 5-year review of PEM physicians' experiences after the death of a child at a single urban pediatric ED. Qualitative thematic analysis was performed on questionnaire responses regarding the resuscitation, debrief, overall support, and opportunities for improvement. RESULTS: Twenty-two PEM physicians provided questionnaire responses to 34 deaths, with no difference in the distribution of number of deaths, sex, or clinical experience between questionnaire respondents and nonrespondents. Six key themes were identified from 34 questionnaire responses: (1) Physicians expressed confidence in the medical aspects of pediatric resuscitation but acknowledged a lack of prehospital information and deliberated airway management. (2) Most physicians found it helpful to have multidisciplinary providers with diverse expertise present during the resuscitation, emphasizing clear leadership and crowd control. (3) Family involvement and communication were crucial during a child's death. (4) Legal and administrative tasks after the death of a child can be burdensome, serving as possible barriers to completing other essential duties. (5) Continued support during and after the death of a child required significant staffing and was essential for resuming ED operations. (6) Staff debriefings occurred frequently and were highly valued, yet encountered challenges in implementation. CONCLUSIONS: PEM physicians highlight that leadership, multidisciplinary collaboration, communication with families, and debriefing are vital components surrounding the death of a child in the ED. Future studies should explore insights from nonphysician health care workers and family members.