The Palliative A-E: An ABCDE approach to assessing and managing End of Life patients for Junior Doctors using simulation teaching

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Background

ABCDE approaches are a proven and effective method of assessment in emergencies but could they be used in end of life care? We developed a simulation teaching station for Foundation Programme Doctors to learn and practice an ABCDE style examination in the unconscious dying patient who cannot communicate symptoms verbally. The aim was to improve the confidence around assessing and managing dying patients.

Methods

A cohort of Foundation Doctors from Gloucestershire Hospitals NHS Trust were presented with a simulation case, assessing an unconscious dying patient. One member assessed the patient with other members contributing ideas. Ultimately the group was taught an ABCDE approach (a structured examination assessing Airway, Breathing, Circulatory, Disability and Exposure aspects, tailored to dying patients) and questioned on management options, with feedback throughout. A survey conducted before and after the teaching aimed to assess the cohort’s confidence in assessing these patients.

Results

The pre-intervention surveys demonstrated low confidence in Junior Doctors in assessing dying patients both before and after graduation with 30 out of 30 and 28 out of 30 candidates feeling somewhat confident or less, respectively. Following the session, confidence in assessing these patients improved with 15 out of 20 feeling very or extremely confident and 100% of candidates finding the session and ABCDE technique useful.

Conclusions

The ABCDE approach to assessing the dying patient appears to improve the confidence Junior Doctors. Simulation teaching allowed for effective demonstration and practice. This method may lead to an improvement in symptom control in our dying hospital patients.