Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital
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. Retrospective chart review of all deceased patients at one children's hospital over 3 years collected patient demog...
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| Veröffentlicht in: | Academic pediatrics 2020-01, Vol.20 (1), p.81-88 |
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| creator | Trowbridge, Amy Bamat, Tara Griffis, Heather McConathey, Eric Feudtner, Chris Walter, Jennifer K. |
| description | 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.
Retrospective chart review of all deceased patients at one children's hospital over 3 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.
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 nonescalation (31%) and failed resuscitation (15%). During their postgraduate year (PGY)-1, |
| doi_str_mv | 10.1016/j.acap.2019.07.008 |
| format | Article |
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Retrospective chart review of all deceased patients at one children's hospital over 3 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.
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 nonescalation (31%) and failed resuscitation (15%). During their postgraduate 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 1 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).
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.</description><identifier>ISSN: 1876-2859</identifier><identifier>EISSN: 1876-2867</identifier><identifier>DOI: 10.1016/j.acap.2019.07.008</identifier><identifier>PMID: 31376579</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; burnout ; Child ; Child, Hospitalized ; Child, Preschool ; end-of-life care ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Internship and Residency ; Male ; palliative care ; pediatrics ; Physician-Patient Relations ; Physicians - psychology ; resident education ; Retrospective Studies ; Terminal Care</subject><ispartof>Academic pediatrics, 2020-01, Vol.20 (1), p.81-88</ispartof><rights>2019 Academic Pediatric Association</rights><rights>Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-5ffb171c6de7a2fce9a25d3514e49ecbe946047f52cec46c11e158a6cc9b3e743</citedby><cites>FETCH-LOGICAL-c455t-5ffb171c6de7a2fce9a25d3514e49ecbe946047f52cec46c11e158a6cc9b3e743</cites><orcidid>0000-0002-5879-0434</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.acap.2019.07.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31376579$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trowbridge, Amy</creatorcontrib><creatorcontrib>Bamat, Tara</creatorcontrib><creatorcontrib>Griffis, Heather</creatorcontrib><creatorcontrib>McConathey, Eric</creatorcontrib><creatorcontrib>Feudtner, Chris</creatorcontrib><creatorcontrib>Walter, Jennifer K.</creatorcontrib><title>Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital</title><title>Academic pediatrics</title><addtitle>Acad Pediatr</addtitle><description>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.
Retrospective chart review of all deceased patients at one children's hospital over 3 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.
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 nonescalation (31%) and failed resuscitation (15%). During their postgraduate 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 1 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).
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.</description><subject>Adolescent</subject><subject>burnout</subject><subject>Child</subject><subject>Child, Hospitalized</subject><subject>Child, Preschool</subject><subject>end-of-life care</subject><subject>Female</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Internship and Residency</subject><subject>Male</subject><subject>palliative care</subject><subject>pediatrics</subject><subject>Physician-Patient Relations</subject><subject>Physicians - psychology</subject><subject>resident education</subject><subject>Retrospective Studies</subject><subject>Terminal Care</subject><issn>1876-2859</issn><issn>1876-2867</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1vEzEQhq0KREvhD_RQ-UYvWexdf61UIVVRoEiRQAiOyHLG48bRZr21NxX992xIG8GFky3PM689fgi54KzijKv3m8qBG6qa8bZiumLMnJAzbrSa1UbpF8e9bE_J61I2jKnGGPWKnDa80Urq9oz8_Io-ujFHoN-wRI_9SBe_BswRe0A6dzn2dzSkTOfr2PmMPXUjHddIF72nKdBlDEjjdHoE3hV6m8oQR9e9IS-D6wq-fVrPyY-Pi-_z29nyy6fP85vlDISU40yGsOKag_KoXR0AW1dL30guULQIK2yFYkIHWQOCUMA5cmmcAmhXDWrRnJMPh9xht9qih2mK7Do75Lh1-dEmF-2_lT6u7V16sKoVQis9BVw9BeR0v8My2m0sgF3neky7YutamYYbI_mE1gcUciolYzhew5nde7Ebu_di914s03byMjVd_v3AY8uziAm4PgA4fdNDxGwL_FHgY0YYrU_xf_m_AUd1oBU</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Trowbridge, Amy</creator><creator>Bamat, Tara</creator><creator>Griffis, Heather</creator><creator>McConathey, Eric</creator><creator>Feudtner, Chris</creator><creator>Walter, Jennifer K.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5879-0434</orcidid></search><sort><creationdate>20200101</creationdate><title>Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital</title><author>Trowbridge, Amy ; Bamat, Tara ; Griffis, Heather ; McConathey, Eric ; Feudtner, Chris ; Walter, Jennifer K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-5ffb171c6de7a2fce9a25d3514e49ecbe946047f52cec46c11e158a6cc9b3e743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>burnout</topic><topic>Child</topic><topic>Child, Hospitalized</topic><topic>Child, Preschool</topic><topic>end-of-life care</topic><topic>Female</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Internship and Residency</topic><topic>Male</topic><topic>palliative care</topic><topic>pediatrics</topic><topic>Physician-Patient Relations</topic><topic>Physicians - psychology</topic><topic>resident education</topic><topic>Retrospective Studies</topic><topic>Terminal Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trowbridge, Amy</creatorcontrib><creatorcontrib>Bamat, Tara</creatorcontrib><creatorcontrib>Griffis, Heather</creatorcontrib><creatorcontrib>McConathey, Eric</creatorcontrib><creatorcontrib>Feudtner, Chris</creatorcontrib><creatorcontrib>Walter, Jennifer K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Academic pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trowbridge, Amy</au><au>Bamat, Tara</au><au>Griffis, Heather</au><au>McConathey, Eric</au><au>Feudtner, Chris</au><au>Walter, Jennifer K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital</atitle><jtitle>Academic pediatrics</jtitle><addtitle>Acad Pediatr</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>20</volume><issue>1</issue><spage>81</spage><epage>88</epage><pages>81-88</pages><issn>1876-2859</issn><eissn>1876-2867</eissn><abstract>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.
Retrospective chart review of all deceased patients at one children's hospital over 3 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.
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 nonescalation (31%) and failed resuscitation (15%). During their postgraduate 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 1 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).
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31376579</pmid><doi>10.1016/j.acap.2019.07.008</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5879-0434</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent burnout Child Child, Hospitalized Child, Preschool end-of-life care Female Hospitals, Pediatric Humans Infant Infant, Newborn Internship and Residency Male palliative care pediatrics Physician-Patient Relations Physicians - psychology resident education Retrospective Studies Terminal Care |
| title | Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital |
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