This document discusses best practices for delivering bad news to patients' loved ones in the emergency department. It recommends using the SPIKES protocol, which involves setting up a private meeting, understanding the relatives' perceptions, getting their permission to share the news, providing small amounts of understandable information while checking for comprehension, acknowledging their emotions, and summarizing while providing support and next steps. Effective communication is important for the patients' families and protects doctors from medico-legal issues. Overall, delivering bad news requires sophisticated communication skills to support the relatives through this difficult time.

1. PRESENTOR
DR. DEEPAK TYAGI
RESIDENT
DEPT OF ORTHOPAEDICS
MGIMS,SEVAGRAM

2. According to Dictionary
A person or thing , who is hurt or killed during an
accident, war and harmed, lost or destroyed or
badly affected by event or situation

3. Also known as
 Emergency department (ED)
 Accident & Emergency Department (A&E)
 Emergency room(ER)
 Emergency ward (EW)

4.  Shock
• CVA
 Cardiac Arrest
 Overdose
 Hematemesis and Melena
 Abdominal Pain
 Head Injuries
 Spinal Injuries
 Wound Management
 Paediatric Respiratory Disorders
 Psychiatric Emergencies
 Chemical Exposure
 Myocardial Infection
 Chest Pain
 Diabetic Ketoacidosis
 Jaundice
 Epilepsy/Convulsions Snake and Spider Bite
 Major Trauma
 Common Fractures
 Respiratory Failure

5.  Medicine
 General surgery
 Orthopaedics
 Obstetrics and gynaecology
 Anaesthesia
 ENT
 Ophthalmology

6.  Immediate Resuscitation
 Emergency
 Urgent
 Semi-urgent
 Non-urgent

7.  Triage
 Primary survey using ABCD Approach :
airway, breathing, circulation and disability
 Secondary survey using EFGHI Approach :
 Exposure to environment
 Full set of vital signs
 Give comfort measures
 History collection
 Inspect the posterior surface

8.  Effective communication is central to the
smooth functioning of complex clinical
environments of casualty department

9.  While treating the patient in casualty proper documentation
is required
 Write down all the vitals in good visible hand writing ‘
Don’t be in hurry while jotting down ‘.
 After assessment and stabilisation of the vitals never feel shy
to take consent from the loved ones of the patient regarding
prognosis of the patient and always explain consent verbally
to loved ones in their local language
 Try to write down consent in local language or language
they understand
 Write down all the treatment in proper order so literate
relatives can understand what has been done to patient by
treating doctor.
 Proper documentation always protect you from medico-
legal issues and consent from the nuisance of the loved ones.

10.  You should always inform the patient to your seniors.
 Never underestimate any symptom
 When patient comes in late evening always admit that
patient .
 When in doubt always admit the patient
 Does patient admission increase workload of the
resident ?
 No, We are here for the care of the patients. It hardly
takes 10-20 min to complete the work up including
writing down the discharge summary
 Always admit the patient of RTA observe them at least
for 24 hours though they are not having any serious
symptom.

11.  How to deal ?
 Patient on Arrival ( brought dead, level of
consciousness, Panic and frightened )
 Differentiate the patient’s condition (emergency
level and selection of patient)
 During Examination ( in presence of relative )
 Help of social worker and nursing staff
 Pain Relief ( must ) and use of charts
 Immediate treatment
 Talking with relatives (always in presence of staff)
 Facts and future condition of patient
 Golden hour rule

12.  Face reading and body language
 Patients who are angry, disrespectful, and
rude
 Draw boundaries with angry patients
 Learning how to say "no" without being
negative
 Apologies can also win over difficult patients
 Inform the patient calmly and politely
 Never delay the treatment and stick to golden
hour treatment

13.  The resident treating a patient facing death
must :
 Attempt to stabilize the patient
 Relieve pain and discomfort
 Decide whether or not to initiate resuscitation
for a obviously terminally ill patient
 communicate with the family
 Understand the emotional reactions of all
members of the emergency medical service

14.  Follow the SPIKES while breaking the bad
news
 Setting up
 Relatives Perception
 Invitation to break news
 Knowledge
 Emotions
 Strategy and summary

15. Setting up :
 Breaking bad news should be done in private.
 Only the his or her loved ones, and members of
the healthcare team should be present.
 The clinician should sit down, make eye
contact with the relatives, and may use touch
appropriately.
 Sufficient time should be allowed to answer
questions. Interruptions (e.g phones) should
be eliminated.

16.  Relative perceptions :
 Before breaking bad news, the doctor should find
out what the relatives knows about his or her
illness.
 Assessing relatives perceptions allows residents to
correct misinformation and tailor the news to the
relatives level of comprehension
 Invitation to break news :
 Doctors need to get the patient’s loved ones
permission to share bad news.

17.  Knowledge :
 Residents should convey information at the
Relatives level of comprehension. For example, the
word spread should be used in place of metastasized.
 To help relatives adequately process bad news,
small boluses of information should be given.
 Residents can check for comprehension by
asking, “Am I making sense?” or “Can I clarify
anything?”
 Undue bluntness and misleading optimism should
be avoided.

18.  Emotions :
 The empathic Resident doctor acknowledges a
relatives emotional response to bad news by
first identifying the emotion and then
responding to it. “I can see that you are upset
by this news” is an empathic statement.
 Deliberate periods of silence allow relatives to
process bad news and ventilate emotions.

19.  Strategy and Summary:
 After receiving bad news, relatives may
experience a sense of isolation and uncertainty.
 Always provide space

20.  Delivering bad news to their loved ones is a very
sensitive task a doctor has to endure.
 It demands a sophisticated level of communication
skills.
 Patient ‘s relatives determine their satisfaction with
their clinicians based on the manner in which the news
is delivered.
 It is, therefore, vital to overemphasise the importance
of doctors’ competency in communication skills.
 Communication can be improved by various simple
techniques like paying attention to barriers to
communication and simple ways of removing barriers
as well as consolidating the information communicated
in a sympathetic way.

21. EMOTIONAL AWARENESS IS NECESSARY SO
YOU CAN PROPERLY CONVEY YOUR
THOUGHTS AND FEELINGS TO OTHER
PERSON

22. ….