Medically Induced Trauma Support Services

[loveanesthesia]

Just returned from the AANA Annual Congress in Boston-many good sessions. A very important topic is the fall out from a poor clinical outcome. Both patients/families and the healthcare providers involved are often traumatized. Medically Induced Trauma Support Services is an organization which is researching and developing resources to assist with the after effects. They advocate that medical facilities should have policies and procedures in place which guide the response to an adverse event. Our hospital does not have any policies-people return to the OR and do the next case. Do you have policies in place?

[offlabel]

Like an unexpected death on the table? No. Such a rare event would garner little support for the effort required to generate a "policy" where I am. The risk management attorneys alone would be enough of a pain to not touch that with a 20 foot pole.

What is the definition of an adverse event? Whatever it might be, "poor clinical outcome" more often than not is mutually exclusive of what most would consider an "adverse event" which I think most would say is injury or death from a catastrophic error, which can take longer to figure out than it takes for the coroner to come get the body.

Could you offer more detail?

[loveanesthesia]

Adverse event could be a death, injury or something else that wasn't planned. It could be due to an error or not. I may consider something an adverse event which causes me stress, while you may not consider the exact same experience an adverse event.

It was suggested that health care providers should be given time and support to deal with the emotional impact of an adverse event. I was wondering if anyplace is doing that?

[offlabel]

Our Chaplain's Office does that sort of thing for deaths in the ICU and maybe ER, not sure. Think they call it a "huddle" or something. Just a brief, multidisciplinary de-briefing to anyone that is interested. A service they offer, but not policy.

[Shanimal]

Our hospital does not have any policies-people return to the OR and do the next case. Do you have policies in place?

Since I'm still an SRNA and haven't started my clinical phase yet, I don't know of any specific OR policies for this, but it's an interesting concept. Moons ago I was an ER nurse, and one department I worked for had an informal policy in place for debriefing after an adverse event. "Adverse event" could've meant a lot of things, but usually it meant a stressful code situation (esp. peds). The intention was to have anyone involved in the event (and who wanted to participate) to meet in a quiet space and talk about the event without placing blame. That kind of debriefing rarely happened in a busy ER though, as you can probably imagine.

Another department I was in utilized "The Pause," which is a tradition that started in the UVA Medical Center ER (several articles written about it too). Basically the way it works is that after any particularly stressful event(s) leading up to a patient's death, those in the room who wanted to participate stood in silence for 60 seconds. The intent was to honor the patient's life and to acknowledge our own efforts in trying to save him or her. I realize it all sounds kind of hippy-dippy, but it actually was rather therapeutic and provided some closure before we all moved on to the next patient. I wonder if it might be a helpful technique to bring into the OR, even if there isn't a specific policy in place for it.