Download - ABC's for Breaking Bad News Following Trauma
Sarah Bryczkowski, MD; Sangeeta Lamba, MD; Anne Mosenthal, MD, FACS; Leslie Tyrie, MD
Follow us on Twitter:
@SarahB_MD @AnneMosenthalMD
ABC’S FOR BREAKING BAD NEWS
FOLLOWING TRAUMA
3.032
2
2.752.6
4.5
4
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Total PGY1 PGY2 PGY3 PGY4 PGY5
Comfo
rtLeve
l
SurgeryResidentPostGraduateYear(PGY)
GeneralSurgeryResidentsComfortLevelforBreakingBadNewsinTrauma,byPostGraduateYear
1: Uncertain 3: Comfortable 5: Very Comfortable
n=8 n=8 n=5 n=6 n=4n=31
A: ANTICIPATE
• Who: Know the team – Nurse, treatment team,
consultants, palliative care/bereavement team, security
• What: Know the details – Results, known injuries,
consultant opinions (this may be incomplete)
• How: Mentally rehearse – Practice in your mind, pre-
meet and prepare the team if appropriate. Organize
events into cause and effect (i.e., blood pressure was
low, so we gave fluids/transfusion).
B: BE AWARE OF SELF AND SURROUNDINGS
• Appearance: Remove blood-splattered clothing. Wear a white coat
• Location: Find a quiet room. Silence your cell
phone/pager if possible
• Safety: Never go alone. Have a safe exit from the room
C: CONVERSATION/CONCERNS GATHER YOUR
TEAM AND START YOUR MEETING
• A: Acquaint yourself with family. ASK what they know.
• B: Begin with a warning - fire the warning shot
• C: Concise summary of events
• D: Do not speak - Allow silence, give space
• E: Empathy/Explain - Recognize emotions, answer
questions, provide next steps. Prepare the family to see
their loved one, or their loved ones body.
D: DOCUMENT, DEBRIEF AND DICTATE
• Document conversation in chart using the ABCDEs
from your conversation. Outline events
• Debrief with your team - Are they emotionally okay?
• Decide who will provide follow-up information to family
• Death - Call the medical examiner, call the sharing
network and dictate discharge summary.
E: ENDING THE ENCOUNTER
• Self-reflect on the encounter
• Think of ways for improvement
• Anticipate needs of the family in the next conversation
• Follow-up with clergy, palliative care team, or
bereavement support
IF YOU HAVE ANY QUESTIONS OR
SUGGESTIONS, PLEASE LET ME KNOW!
Sarah Bryczkowski, MD
Rutgers – New Jersey Medical School
This work was presented at:
Association for Surgical Education, 11 th Annual Thinking Out of the Box
Luncheon on April 10, 2014 in Chicago, IL during Surgical Education Week
Thank You!
