TOP 15 - Feasibility of a Modified PAUSE (Promoting Acknowledgement, Unity, and Sympathy at the End of Life) Intervention in the Pediatric Emergency Department

Publication Number: 4717.TOP 15

Rachael A. Herriman, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Heidi Werner, University of California, San Francisco, School of Medicine, San Mateo, CA, United States; Shruti Kant, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Elizabeth L.. Seashore, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Myrka P. Macedo, University of California, San Francisco, School of Medicine, Sanger, CA, United States; Kevin Li, Robert Larner, M.D., College of Medicine at the University of Vermont, Winooski, VT, United States; Dina Wallin, UCSF Benioff Children's Hospital San Francisco, san francisco, CA, United States

Background: Deaths in the pediatric emergency department (PED) are rare but profoundly distressing events that may contribute to provider burnout and moral distress. The Promoting Acknowledgement, Unity, and Sympathy at the End of Life (PAUSE) is a brief, structured reflection to foster team cohesion and meaning-making following patient death. Developed and previously used in adult settings, the PAUSE has not been evaluated in pediatric emergency settings.

Objective: To assess the feasibility of implementing a pediatric-adapted PAUSE intervention in the PED.

Design/Methods: This mixed-methods pilot study is being conducted at UCSF Benioff Children's Hospitals-Oakland and Mission Bay (July 2024 - January 2026). Fellows, attendings, and charge nurses completed structured training to lead a pediatric-adapted PAUSE developed through a modified Delphi process with input from emergency, palliative, and spiritual care providers.

Feasibility is assessed through:
Implementation metrics: proportion of pediatric deaths followed by a PAUSE and training coverage among key staff.
Pre- and post-surveys: 5-point Likert-scale items across feasibility domains (demand, acceptability, implementation, practicality, integration).
Qualitative focus groups: exploring barriers, facilitators, emotional impact, and sustainability, analyzed thematically (Braun & Clarke) guided by the CFIR framework.

Quantitative analyses will summarize feasibility domain distributions and compare pre- and post-survey responses using unpaired methods, with sensitivity analyses for repeated observations. Qualitative data will undergo thematic analysis guided by the CFIR framework. The study was approved by the UCSF Institutional Review Board, and final analyses will be completed by January 2026.

Workflow Integration of the PAUSE Following Pediatric Death
Following a patient death in the pediatric emergency department, the PAUSE provides a brief, structured moment of reflection before care providers resume patient care duties.

Overview of the Modified PAUSE and Evaluation Timeline