SUDDEN UNEXPECTED DEATH IN THE EMERGENCY DEPARTMENT - CARING FOR THE SURVIVORS

Objective: To determine whether emergency department staff met the nee ds of the next of kin and close friends (''survivors'') of patients dy ing in an emergency department and to assess the effectiveness of a pr ogram to improve care of survivors. Design: Mail survey before and aft er program implementation. Setting: Emergency department of a tertiary care, adult teaching hospital. Participants: Two groups of survivors, identified through a review of emergency department records of deaths during two 6-month periods. In the first group, surveyed in 1987, bef ore program implementation, 26 (53%) of 49 responded; in the second gr oup, surveyed in 1990, after program implementation, 40 (70%) of 57 re sponded. Interventions: A structured, multidisciplinary protocol for n otifying next of kin of death and supporting the survivors was impleme nted. An educational program was provided to all emergency department staff. An information pamphlet was created and provided to survivors. Main outcome measures: Questionnaire responses regarding the adequacy and timeliness of information provided, the support and actions by eme rgency department staff and the survivors' desire to be present during resuscitation efforts. Results: Comparison of responses before and af ter program implementation showed that adequate information was provid ed before notification of death in 32% and 83% of cases respectively ( p < 0.001), lengthy delays in receiving medical information occurred i n 60% and 15% of cases (p < 0.01), adequate medical information concer ning the events of death was provided in 53% and 88% (p < 0.05), the p resence of emergency department staff was sufficient in 40% and 79% (p < 0.01), survivors spent less than 2 hours in the emergency departmen t in 50% and 81% (p < 0.05), and survivors expressed a desire to be pr esent during resuscitation efforts in 95% and 11% of cases (p < 0.001) . Conclusion: The grievous experience of learning that a loved one has suddenly and unexpectedly died in the emergency department can be all eviated somewhat by a structured, multidisciplinary approach combined with staff sensitization and education.