Perinatal-Neonatal Fellow Seattle Children's Seattle, Washington, United States
Background: The death of a child is a devastating loss for a family with grief that may be complex and long-lasting. After death, families report feeling abandoned by their medical team, who were previously integrated into the family’s structure during many weeks and months in the hospital. Communication from providers intimately involved in the deceased child’s care can provide comfort and meaning as a family processes their loss. Our neonatal intensive care unit (NICU) lacks specific policies or guidance around post-death communication and practices appear inconsistent. Of all patients who died in our Level IV NICU from January 2021 to September 2023 (n=61), only twenty percent (n=12) had EMR documentation of communication between family and neonatologist after patient death. Objective: The aim of this QI project is to increase the rate of attending physician documented follow-up with families after NICU death from 20% to 40% by April 2024. In so doing, we hope to improve family support by providers who played an integral role in their infant’s life and death. Design/Methods: The primary drivers are the standardization of both bereavement follow-up practices and associated EMR documentation. We will survey neonatology faculty to assess their current bereavement communication practices. Our institutional NICU QI microsystems team, comprised of key personnel including a family representative, social work, and center for diversity and equity representative, will advise on development of guidelines for bereavement communication. These guidelines will be vetted by our NICU faculty at a division QI conference. The dissemination of unit standards will involve several iterations of staff education, the integration of specific elements and documentation in the EMR, and the creation of a job aid to facilitate its use. Adherence to guidelines will be measured after rollout of guidelines and documentation by a review of deceased patient charts. This QI project does not require IRB oversight.
