| A: Anticipate: Who, what, how |
- Who: Know the team – Clinicians, nurses, consultants, palliative care/bereavement, security.
- What: Know the details – Clinical course, test results, interventions, conditions/injuries sustained, consultant opinions (may be incomplete).
- How: Mentally rehearse – Practice in your mind; meet and prepare the team in advance if appropriate. Organize events into cause and effect (eg, "Mr. Smith had extreme difficulty breathing, so we placed a breathing tube").
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| B: Be aware of yourself and your surroundings |
- Appearance: Change and remove any blood-splattered or unsightly clothing. You may want to wear a white coat.
- Location: Use a quiet room. Silence your cell phone and pager if possible.
- Safety: Try not to go alone. Ensure you have ready access to a safe exit from the room.
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| C: Conversation and concerns |
- Introduce yourself to the family.
- Begin with a warning (eg, "I'm afraid I have some bad news").
- Give a concise summary of events (describe the big picture and most important events).
- Allow for silence; give the family time to process, grieve, and ask questions.
- Recognize emotions, answer questions, and describe next steps.
- Prepare the family to see their loved one as necessary. Warn them about appearance and any medical devices (eg, "A breathing tube is still in place").
- Provide resources for the family as necessary (eg, social worker, bereavement counselor, chaplain, funeral home).
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| D: Debrief and documentation |
- Document your conversation using the ABCDE mnemonic as a guide.
- Debrief with your team (may not be on the same day).
- Death – Call the medical examiner; call the sharing network.
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| E: Ending the encounter |
- Reflect on the encounter; consider ways to improve: what went well, and what did not?
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