Deutsch Stephanie Anne, Macaulay Jennifer L, Smith Nadine, De Jong Allan
Nemours Children's Health , Delaware.
Dela J Public Health. 2022 May 31;8(2):14-20. doi: 10.32481/djph.2022.05.003. eCollection 2022 May.
To establish a standardized, trauma informed and family-centered emergency department (ED) sudden and unexpected infant death (SUID) management protocol at Nemours Children's Health, Delaware for medical professionals and multidisciplinary team (MDT) collaborators, informed by national clinical practice guidance, and respective of both family and investigative needs. SUID are emotionally distressing for involved family members, often precipitated by profound grief and confusion as the family interacts with many mandated public agencies during the course of a medicolegal death investigation. Although SUID necessitates consideration of child abuse and neglect as a contributory factor, and accurate determination of death cause may have critical implications for other family members and public health, prioritizing family needs in a trauma informed manner is paramount. Collaboration between MDT partners to provide optimal care to families following SUID involves transparent family communication, attending to medical and mental health needs of surviving family (especially siblings), and respecting medicolegal investigative constraints. Many institutions lack standardized approaches to SUID cases, which may precipitate increased family distress and delay initiation of necessary medicolegal death procedures.
An MDT expert panel consisting of medical, legal, law enforcement, and child welfare professionals was convened at Nemours Children's Health, Delaware in 2018 over a 3-month period to analyze and implement an enhanced, family-centered, trauma informed hospital protocol.
Using exploratory inquiry and dialogue to elicit important protocol goals, a family-centered protocol with revised, coordinated roles for MDT members was developed with enhanced focus on communication, family-, and team-oriented care.
Implementation of a family-centered, ED-based protocol standardizing the approach to SUID effectively supports medicolegal death investigative procedures while prioritizing trauma informed, supportive, sensitive ED care for grieving families.
Health care institutions serving children and their families should develop and implement trauma informed, family-centered protocols to ensure sensitivity during medicolegal death investigations.
根据国家临床实践指南，并兼顾家庭和调查需求，为特拉华州内穆尔儿童健康中心的医学专业人员和多学科团队（MDT）合作人员制定一项标准化、关注创伤且以家庭为中心的急诊科（ED）婴儿猝死（SUID）管理方案。婴儿猝死会让相关家庭成员情绪痛苦，在法医学死亡调查过程中，家庭与许多法定公共机构互动时，往往会因极度悲伤和困惑而加剧这种痛苦。尽管婴儿猝死需要考虑虐待和忽视儿童这一促成因素，准确确定死因可能对其他家庭成员和公共卫生具有关键意义，但以关注创伤的方式优先满足家庭需求至关重要。MDT合作伙伴之间的协作，以便在婴儿猝死之后为家庭提供最佳护理，这包括与家庭进行透明沟通、关注幸存家庭成员（尤其是兄弟姐妹）的医疗和心理健康需求，以及尊重法医学调查限制。许多机构缺乏针对婴儿猝死病例的标准化方法，这可能会加剧家庭痛苦，并延迟启动必要的法医学死亡程序。
2018年，一个由医学、法律、执法和儿童福利专业人员组成的MDT专家小组在特拉华州内穆尔儿童健康中心召开了为期3个月的会议，以分析并实施一项强化的、以家庭为中心、关注创伤的医院方案。
通过探索性询问和对话来确定重要的方案目标，制定了一项以家庭为中心的方案，其中MDT成员的角色经过修订和协调，更加注重沟通、以家庭和团队为导向的护理。
实施以家庭为中心、基于急诊科的方案，对婴儿猝死的处理方法进行标准化，这有效地支持了法医学死亡调查程序，同时优先为悲伤的家庭提供关注创伤、支持性和体贴的急诊科护理。
为儿童及其家庭提供服务的医疗机构应制定并实施关注创伤、以家庭为中心的方案，以确保在法医学死亡调查期间保持体贴。
