Objective: The project intended to describe the format of the Wrap-up, a unique multidisciplinary guided debriefing following a child's death. Specific feedback from pediatric residents was sought to assess the model. Methods: The Wrap-ups were timely (within 48 hours of a death), consistent (conducted after each pediatric intensive care unit (PICU) death), multidisciplinary (all care providers were invited), and specifically conducted by someone trained in postdeath facilitation. The role of the conductor was focused on being inclusive, navigating the discussion, diffusing areas of conflict or angst, and managing the tone of the meeting. , there were 36 PICU deaths. The average age was nine years old. All deaths had an accompanying conductor-led Wrap-up occurring, on average, two days after the death. Sixty percent (27/45) of pediatric residents completed the survey. Their qualitative responses showed that the key components (timely, multidisciplinary, and specifically conducted) of the Wrap-ups were valuable. Quantitatively, they agreed or strongly agreed that the consistent Wrap-ups improved end-of-life care, teamwork, stress surrounding the death, and the ability to care for others. Conclusion: The Wrap-up, a unique forum for debriefing after a pediatric death, was well-received by residents and assisted them with processing, understanding, and resolving their experience regarding the pediatric death. The Wrap-up was a valuable addition to residents' experience and education in pediatric critical care medicine and can be replicated in other institutions.

Hami is a 3-year-old boy who is a former premature 25-week infant with a birth weight of 1 pound 9 ounces. He had a relatively smooth Neonatal Intensive Care Unit (NICU) course; he required intubation for 1 month and went home on room air. He had a left Grade I intraventricular hemorrhage that was resolved by 2 months of life. He had 7 blood transfusions for anemia over the first 3 months of life. A brainstem auditory evoked potential test was normal at hospital discharge, and he showed no evidence of retinopathy of prematurity. He never had seizure activity.He was discharged to home at 3 months where he did well and thrived on a high calorie formula. He walked at 17 months and spoke his first words at 2 years. He was enrolled in Early Intervention at the time of discharge from hospital; monthly home visits were increased to weekly visits by an early childhood educator at 12 months. When he was 12 months, he was enrolled in a family day care with 4 other children younger than 3 years. Hami's language development was slow; at 2.5 years of age, he was beginning to make 2 word combinations. Early intervention services were increased to include an additional hour of speech and language therapy as well as a play group.Hami's mother is 33 years old, and this is her first child. She worked as an accounting assistant, but she was able to be home with Hami for the first year of his life. She returned to full-time work on his first birthday. Hami's father is 35 years old and works for the national electrical grid as a manager. They are not married but have lived together for the last 5 years. Dad works evenings and cares for Hami from 4 to 6 pm after childcare; mom returns from work at 6 pm. Dad leaves for work at 7 pm and works till 2 am. Their relationship has been strained by the child care demands, their work schedules, and Hami's developmental progress.Hami's primary care pediatrician specializes in children with complex medical problems. The parents express concern at the 3-year-old visit that Hami's language is not progressing as it should be. They are concerned that he is much more active than the other 3 year olds in his child care setting. Early intervention has initiated the transition process to a public school placement, and the parents are very concerned that he is too young, too active, and too much of a handful to be "in the big public school." What would you do next?

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