Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Eleanor Reid

Abstract

BackgroundGlobally, violence against healthcare workers in Emergency Departments (EDs) is alarmingly common and increasing in prevalence. While workplace violence is possible in any patient encounter, disclosure of traumatic deaths to family and friends may be uniquely high-risk.

Research AimsThe objective of this study is to establish consensus guidelines with multidisciplinary staff to improve safety in the emergency department of a large, urban, Level I trauma center when disclosing traumatic deaths.

HypothesisInterdisciplinary professionals in an emergency department can create consensus around best practices to improve safety in the ED when disclosing traumatic deaths.

MethodsWe conducted this study using a modified Delphi approach. Participants were interdisciplinary healthcare workers and students at a large academic hospital in New England. We conducted three rounds of surveys and two focus groups to identify a discrete set of recommendations to improve safety when disclosing traumatic deaths. All survey rounds and meetings took place between May 4th, 2025 and July 21st, 2025.

ResultsWe initially invited 17 interdisciplinary experts to participate. 14 experts participated in the survey rounds, meeting rounds, or both; including two emergency medicine attendings, two emergency medicine residents, two surgery attendings, one surgery resident, two social workers, one security team member, two medical students, and two chaplains. We identified 19 recommendations that met the consensus threshold of ≥3.75/5.

Scientific Impact and RelevanceWe developed an interdisciplinary, consensus-based set of guidelines that prioritizes both staff safety and compassionate care during disclosure of traumatic death. These recommendations span behavioral expectations, staffing protocols, physical space design, and team debriefing, offering a comprehensive and interdisciplinary framework. The findings from this work have been written into policy and approved for utilization at a large, urban, Level I trauma center, demonstrating institutional commitment to protecting healthcare workers during high-stakes communication in the emergency setting, and allowing for further implementation research with follow-on plans to evaluate effectiveness. A simulation center in affiliation with the site has been engaged for integrated training on the policy, and there are plans for engagement with site facilities to implement physical plant aspects of the recommendations.

Comments

This is an Open Access Thesis.

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