An unsuccessful resuscitation: The families' and doctors' experiences of the unexpected death of a patient

Abstract

Background: The objective was to elicit families' experience of the death of a family member at the Elsies River Community Health Centre, their feelings towards the staff involved in the resuscitation and their opinions about how things could be improved. The study also elicited the doctors' experiences of communicating with the families of patients who had died in the emergency unit.

Methods: This was a qualitative study, using free attitude interviews for family members and focus group discussions for doctors. Twelve family members whose loved ones had died in the emergency room and 15 doctors who worked in the emergency room were included.

Results: Key themes were identified, relating to issues in the pre-resuscitation period, the resuscitation, breaking the bad news, after breaking the bad news and post-event sequelae. In the pre-resuscitation period, there were problems in admitting, identifying and responding to acutely ill patients. During the resuscitation, the families and staff disagreed about witnessing the resuscitation. Breaking the bad news was often difficult for the doctors and hindered by the physical environment. Afterwards, there were mixed feelings about the quality of emotional support, the use of medication and bereavement counselling. All agreed that viewing the body was helpful and funeral
arrangements were not a problem. There was no effective follow-up of the families and the doctors also experienced increased stress following unsuccessful resuscitations.

Conclusion: The study found that the role of security staff should be clarified and a better triage system established to enable critically ill patients to be seen promptly. Families should be given the option of viewing the resuscitation and always be kept informed of progress. Doctors need better training in communication skills and breaking bad news, which should be done in a private area. Families should also be given the opportunity to view the body.
Families should be assisted with contacting the undertaker and a follow-up visit should be organised after the initial shock, when further questions can be asked and abnormal grief reactions identified. Bereavement counselling should be available and community-based resources should be identified in this regard. Debriefing should also be available for staff involved in unsuccessful resuscitations.

SA Fam Pract 2004;46(8): 20-25