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Paxino J, Szabo RA, Marshall S, Story D, Molloy E. What and when to debrief: a scoping review examining interprofessional clinical debriefing. BMJ Qual Saf 2024; 33:314-327. [PMID: 38160060 DOI: 10.1136/bmjqs-2023-016730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts. METHODS Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches. RESULTS Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD. CONCLUSIONS The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca A Szabo
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Marshall
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Story
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Molloy
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Phua GLG, Owyong JLJ, Leong ITY, Goh S, Somasundaram N, Poon EYL, Chowdhury AR, Ong SYK, Lim C, Murugam V, Ong EK, Mason S, Hill R, Krishna LKR. A systematic scoping review of group reflection in medical education. BMC MEDICAL EDUCATION 2024; 24:398. [PMID: 38600515 PMCID: PMC11007913 DOI: 10.1186/s12909-024-05203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. METHODS A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. RESULTS 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. CONCLUSIONS Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.
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Affiliation(s)
- Gillian Li Gek Phua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, 463 Clementi Road, Singapore, Singapore
| | - Ian Tze Yong Leong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Suzanne Goh
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- KK Women's and Children Hospital, 100 Bukit Timah Rd, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Vengadasalam Murugam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, Singapore
- Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, 31 Third Hospital Ave, Singapore, 168753, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Ruaridh Hill
- Health Data Science, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, Singapore, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
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Grither A, Leonard K, Whiteley J, Ahmad F. Development, Implementation, and Provider Perception of Standardized Critical Event Debriefing in a Pediatric Emergency Department. Pediatr Emerg Care 2024; 40:292-296. [PMID: 37590932 DOI: 10.1097/pec.0000000000003030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Hot debriefings are communications among team members occurring shortly after an event. They have been shown to improve team performance and communication. Best practice guidelines encourage hot debriefings, but these are often not routinely performed. We aim to describe the development and implementation of a multidisciplinary hot debriefing process in our pediatric emergency department (ED), and its impact on hot debriefing completion and provider perceptions. METHODS An internal tool and protocol for hot debriefings were developed by integrating responses from a survey of those who work in the ED at our institution and previously published debriefing tools. Charge nurses and pediatric emergency medicine physicians were trained to lead hot debriefings. Surveys on the perception of hot debriefings were administered before and 6 months postimplementation.Twelve-month baseline data were established by asking physicians who cared for patients who died in the ED or within 48 hours of admission to recall debrief completion. Debriefs were then prospectively tracked for 6 months postimplementation. RESULTS Debrief completion for patient deaths in the ED or within 48 hours of admission increased from 23% (5/22) to 75% (12/16) ( P < 0.001). When assessing just those deaths within the ED, this number increased from 31% (5/16) to 85% (11/13) ( P < 0.001).There were 98 responses to a baseline survey (response rate, 60.5%). Most who were surveyed felt that debriefs rarely occurred, preferred hot debriefings to cold debriefings, and felt that more hot debriefings should occur. Perceived barriers included lack of time, interest, protocol, trained facilitators, departmental support, and inability to gather the team.There were 88 responses to a postintervention survey (response rate, 56.8%), 50 of which had participated in a debrief and were included in analysis. Those surveyed felt that debriefs occurred more often and were more often valuable. Most perceived that barriers were significantly reduced. Most respondents felt that hot debriefs helped address systems issues and improved performance. CONCLUSIONS Implementation of a protocol for physician or charge nurse-led hot debriefings in our pediatric ED resulted in increased completion, perceived barrier reduction, and a uniform approach to address identified issues. Pediatric EDs should consider adoption of a hot debriefing protocol given these benefits.
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Affiliation(s)
- Allie Grither
- From the Division of Emergency Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Kathryn Leonard
- From the Division of Emergency Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Jill Whiteley
- Emergency Department, Saint Louis Children's Hospital, St. Louis, MO
| | - Fahd Ahmad
- From the Division of Emergency Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
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Francis-Wenger H. Exploring compassion satisfaction and compassion fatigue in emergency nurses: a mixed-methods study. Emerg Nurse 2024; 32:19-26. [PMID: 37278088 DOI: 10.7748/en.2023.e2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Compassion fatigue can have detrimental effects on emergency nurses and the quality of patient care they deliver. Ongoing challenges such as operational pressures and the coronavirus disease 2019 (COVID-19) pandemic may have increased nurses' risk of experiencing compassion fatigue. AIM To explore and understand emergency nurses' experiences and perceptions of compassion satisfaction and compassion fatigue. METHOD This study used an explanatory sequential mixed-methods design comprising two phases. In phase one, the Professional Quality of Life (ProQOL-5) scale was used to obtain information on the prevalence and severity of compassion satisfaction and compassion fatigue among emergency nurses. In phase two, six participants' experiences and perceptions were explored via semi-structured interviews. FINDINGS A total of 44 emergency nurses completed the ProQOL-5 questionnaires. Six respondents had a high compassion satisfaction score, 38 had a moderate score and none had a low score. In the interviews, participants revealed different explanations regarding their compassion satisfaction levels. Three main themes were identified: personal reflections; factors identified as maintaining stability; and external factors affecting compassion. CONCLUSION Compassion fatigue needs to be prevented and addressed systemically to avoid detrimental effects on ED staff morale and well-being, staff retention, patients and care delivery.
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Peta D, Navarroli JE. Supporting a Healthy Work Environment and Just Culture in the Emergency Care Setting. J Emerg Nurs 2024; 50:305-311. [PMID: 38453345 DOI: 10.1016/j.jen.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 03/09/2024]
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Davis K, Kessler D, Lemke D, Doughty C. Applied Improvisation: Putting Behavioral Skills Center Stage in Simulation-Based Team Training. Simul Healthc 2024:01266021-990000000-00108. [PMID: 38421367 DOI: 10.1097/sih.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
SUMMARY STATEMENT Behavioral skills, sometimes referred to as nontechnical skills or team-based skills, are fundamental to simulation-based team training. These skills should be afforded the same deliberate practice and development as clinical knowledge and procedural skills in health care education. Applied improvisation, the use of theater games designed to improve individual and team performance, is gaining traction in health care education to train behavioral skills. Simulation educators are experts in experiential learning with debriefing and therefore well poised to incorporate applied improvisational exercises into team training activities.
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Affiliation(s)
- Kasey Davis
- From the Division of Critical Care Medicine (K.D.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Division of Emergency Medicine (D.K.), Columbia University College of Physicians and Surgeons, New York, NY; Division of Emergency Medicine (D.L., C.D.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; and Simulation Center (K.D., D.L., C.D.), Texas Children's Hospital, Houston, TX
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Phillips EC, Smith SE, Tallentire V, Blair S. Systematic review of clinical debriefing tools: attributes and evidence for use. BMJ Qual Saf 2024; 33:187-198. [PMID: 36977575 DOI: 10.1136/bmjqs-2022-015464] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Clinical debriefing (CD) following a clinical event has been found to confer benefits for staff and has potential to improve patient outcomes. Use of a structured tool to facilitate CD may provide a more standardised approach and help overcome barriers to CD; however, we presently know little about the tools available. This systematic review aimed to identify tools for CD in order to explore their attributes and evidence for use. METHODS A systematic review was conducted in line with PRISMA standards. Five databases were searched. Data were extracted using an electronic form and analysed using critical qualitative synthesis. This was guided by two frameworks: the '5 Es' (defining attributes of CD: educated/experienced facilitator, environment, education, evaluation and emotions) and the modified Kirkpatrick's levels. Tool utility was determined by a scoring system based on these frameworks. RESULTS Twenty-one studies were included in the systematic review. All the tools were designed for use in an acute care setting. Criteria for debriefing were related to major or adverse clinical events or on staff request. Most tools contained guidance on facilitator role, physical environment and made suggestions relating to psychological safety. All tools addressed points for education and evaluation, although few described a process for implementing change. Staff emotions were variably addressed. Many tools reported evidence for use; however, this was generally low-level, with only one tool demonstrating improved patient outcomes. CONCLUSION Recommendations for practice based on the findings are made. Future research should aim to further examine outcomes evidence of these tools in order to optimise the potential of CD tools for individuals, teams, healthcare systems and patients.
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Affiliation(s)
- Emma Claire Phillips
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
| | - Victoria Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
| | - Sheena Blair
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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Ortiz-Movilla R, Beato-Merino M, Funes Moñux RM, Martínez-Bernat L, Domingo-Comeche L, Royuela-Vicente A, Román-Riechmann E, Marín-Gabriel MÁ. What is the Opinion of the Health Care Personnel Regarding the Use of Different Assistive Tools to Improve the Quality of Neonatal Resuscitation? Am J Perinatol 2024. [PMID: 38190977 DOI: 10.1055/a-2240-2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE It is important to determine whether the use of different quality improvement tools in neonatal resuscitation is well-received by health care teams and improves coordination and perceived quality of the stabilization of the newborn at birth. This study aimed to explore the satisfaction of personnel involved in resuscitation for infants under 32 weeks of gestational age (<32 wGA) at birth with the use of an assistance toolkit: Random Real-time Safety Audits (RRSA) of neonatal stabilization stations, the use of pre-resuscitation checklists, and the implementation of briefings and debriefings. STUDY DESIGN A quasi-experimental, prospective, multicenter intervention study was conducted in five level III-A neonatal intensive care units in Madrid (Spain). The intervention involved conducting weekly RRSA of neonatal resuscitation stations and the systematic use of checklists, briefings, and debriefings during stabilization at birth for infants <32 wGA. The satisfaction with their use was analyzed through surveys conducted with the personnel responsible for resuscitating these newborns. These surveys were conducted both before and after the intervention phase (each lasting 1 year) and used a Likert scale response model to assess various aspects of the utility of the introduced assistance tools, team coordination, and perceived quality of the resuscitation. RESULTS Comparison of data from 200 preintervention surveys and 155 postintervention surveys revealed statistically significant differences (p < 0.001) between the two phases. The postintervention phase scored higher in all aspects related to the effective utilization of these tools. Improvements were observed in team coordination and the perceived quality of neonatal resuscitation. These improved scores were consistent across personnel roles and years of experience. CONCLUSION Personnel attending to infants <32 wGA in the delivery room are satisfied with the application of RRSA, checklists, briefings, and debriefings in the neonatal resuscitation and perceive a higher level of quality in the stabilization of these newborns following the introduction of these tools. KEY POINTS · RRSA, checklists, briefings, and debriefings improve the quality of neonatal resuscitation at birth.. · These tools, when used together, are well-received and enhance perceived resuscitation quality.. · Perception of utility and quality improvement is consistent across roles and experience..
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Affiliation(s)
- Roberto Ortiz-Movilla
- Pediatric Service, Neonatology Unit, Puerta de Hierro-Majadahonda University Hospital, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
| | - Maite Beato-Merino
- Pediatric Service, Neonatology Unit, Severo Ochoa University Hospital, Leganés, Madrid, Spain
| | - Rosa María Funes Moñux
- Pediatric Service, Neonatology Unit, Príncipe de Asturias University Hospital, Universidad de Alcalá de Henares, Madrid, Spain
| | - Lucía Martínez-Bernat
- Pediatric Service, Neonatology Unit, Getafe University Hospital, Getafe, Madrid, Spain
| | - Laura Domingo-Comeche
- Pediatric Service, Neonatology Unit, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain
| | - Ana Royuela-Vicente
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute, CIBERESP, Madrid, Spain
| | - Enriqueta Román-Riechmann
- Pediatric Service, Puerta de Hierro-Majadahonda University Hospital, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
| | - Miguel Ángel Marín-Gabriel
- Pediatric Service, Neonatology Unit, Puerta de Hierro-Majadahonda University Hospital, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
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Fitzgerald K, Knight J, Valji K. Enhancing your practice: debriefing in interventional radiology. CVIR Endovasc 2024; 7:12. [PMID: 38227127 DOI: 10.1186/s42155-023-00412-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024] Open
Abstract
LEARNING OBJECTIVES Review the history of debriefing and provide an Interventional Radiologist (IR) specific framework for leading an effective debrief. BACKGROUND A debrief is often regarded as a meeting with persons who were involved in a stressful, traumatic and/or emotionally challenging situation to review processes, communicate concerns or gather feedback. The goals of these sessions can be for learning/quality improvement (QI) or psychological/emotional support, or a mix of both. Debriefing after tough situations has become a standard tool of many medical specialties, such as surgery, critical care and emergency medicine, with specialty specific literature available. However, there is a paucity of Interventional Radiology specific literature available for debriefing techniques. CLINICAL FINDINGS/PROCEDURE DETAILS We will review the history and types of debriefing and why a debrief could be considered. We will provide a framework for leading a successful debrief in Interventional Radiology. CONCLUSION Debriefing can be a useful tool for learning and QI as well as psychological or emotional support after a challenging or tough situation. Debriefing can address multiple variables and can stylistically be tailored to suit specific needs. IRs have an opportunity to take a leadership role in debriefing, providing comfort and quality improvement through communication and support.
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Affiliation(s)
- Kara Fitzgerald
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA.
| | - Jesse Knight
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA
| | - Karim Valji
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA
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Alali KF, Crouse HL, Rus MC, Marton S, Haq H. Debriefing Trainees After Global Health Experiences: An Expert Consensus Delphi Study. Acad Pediatr 2024; 24:155-161. [PMID: 37524166 DOI: 10.1016/j.acap.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Global health (GH) opportunities in pediatric residencies are prevalent. Debriefing trainees after a GH experience is a tool to optimize educational processing, identify post-return stressors, and facilitate coping skills; however, there are no consensus recommendations for debriefing in this context. OBJECTIVE Our objective was to develop structure and content guidelines for standardized debriefing of residents returning from short-term clinical GH rotations abroad. METHODS Through a modified Delphi methodology, we developed a standardized consensus-based debriefing tool. Eleven pediatric GH education experts were recruited. Experts were individuals with leadership experience in GH education who demonstrated academic engagement by either primary or senior authorship of a publication or relevant presentation at a conference. The expert panel (EP) completed 4 surveys that were amended after each round based on qualitative data, which was assessed for emergent themes. In the final round, the EP rated each consensus recommendation in importance using a 4-point Likert scale. RESULTS Ten of the 11 panelists completed all study rounds. The EP achieved consensus that residents should complete post-return debriefing and rated 32 consensus recommendations in importance. Twelve recommendations were deemed "essential"; these debriefing recommendations focused on timing and preparation, reflection and feedback, trainee well-being and coping skills, ethical concerns, and the need to provide mental health support and resources for trainees with psychological distress. CONCLUSIONS According to GH experts, all residents who participate in GH experiences should participate in a post-return debrief. Thirty-two consensus recommendations regarding content, timing, structure, and actions for post-return debriefing were formulated.
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Affiliation(s)
| | - Heather L Crouse
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Marideth C Rus
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Stephanie Marton
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex.
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Soriano P, Kanis J, Abulebda K, Schwab S, Coffee RL, Wagers B. Determining the Association Between Emergency Department Crowding and Debriefing After Pediatric Trauma Resuscitations. Pediatr Emerg Care 2023; 39:848-852. [PMID: 36728549 DOI: 10.1097/pec.0000000000002900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Debriefing in the pediatric emergency department (PED) is an invaluable tool to improve team well-being, communication, and performance. Despite evidence, surveys have reported heavy workload as a barrier to debriefing leading to missed opportunities for improvement in an already busy ED. The study aims to determine the association between the incidence of debriefing after pediatric trauma resuscitations and PED crowding. METHODS A total of 491 Trauma One activations in Riley Children's Hospital Pediatric Emergency Department that presented between April 2018 to December 2019 were included in the study. Debriefing documentations, patient demographics, time and date of presentation, mechanism of injury, injury severity score, disposition from PED, and length of stay (LOS) were collected and analyzed. The National Emergency Department Overcrowding Scale score at arrival, Average LOS, total PED census, total PED waiting room census, and rates of left without being seen were compared between groups. RESULTS Of 491 Trauma One activations presented to our PED, 50 (10%) trauma evaluations had documented debriefing. The National Emergency Department Overcrowding Scale score at presentation was significantly lower in those with debriefing versus without debriefing. In addition, the PED hourly census, waiting room census, average LOS, and left without being seen were also significantly lower in the group with debriefing. In addition, trauma cases with debriefing had a higher proportion of patients with profound injuries and discharges to the morgue. CONCLUSIONS Pediatric emergency department crowding is a significant barrier to debriefing after trauma resuscitations. However, profound injuries and traumatic pediatric deaths remain the strongest predictors in conducting debriefing regardless of PED crowding status.
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Affiliation(s)
- Pamela Soriano
- From the Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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Neeley M, Crook TW, Gigante J. This Encounter Isn't Over Yet: The Importance of Debriefing. Pediatrics 2023; 152:e2023063198. [PMID: 37551525 DOI: 10.1542/peds.2023-063198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Maya Neeley
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Travis W Crook
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joseph Gigante
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and Vanderbilt University School of Medicine, Nashville, Tennessee
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Mullan PC, Jennings AD, Stricklan E, Martinez E, Weeks M, Mitchell K, Vazifedan T, Andam-Mejia R, Spencer DB. Reducing physical restraints in pediatrics: A quality improvement mixed-methods analysis of implementing a clinical debriefing process after behavioural health emergencies in a Children's Hospital. Curr Probl Pediatr Adolesc Health Care 2023; 53:101463. [PMID: 38000959 DOI: 10.1016/j.cppeds.2023.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
INTRODUCTION An increasing number of pediatric patients with mental and behavioral health (MBH) conditions present to Emergency Department (ED) and inpatient settings with behavioral events that require physical restraint (PR). PR usage is associated with adverse outcomes. Clinical debriefing (CD) programs have been associated with improved performance but have not been studied in this population. After implementing an MBH-CD program in our Children's Hospital, we aimed to decrease the baseline (7/2018-3/2021) rate of a second PR episode (2PR) by 50 % in the ED and inpatient settings over two years. METHODS A multidisciplinary team implemented an MBH-CD process in April 2021 for hospital teams to use immediately after behavioral events. We included patients ≤18 years old, with an ED or inpatient discharge MBH diagnosis, between July 2018 and June 2023. Pre- and post-implementation secondary outcomes included the ED median duration of PR and the ED PR time per 1000 h of ED care. ED and inpatient mean length of stay (LOS) and mean monthly visits (MMV) in pre- and post-implementation were also compared. Qualitative analysis identified major themes. RESULTS Post-implementation, the ED significantly decreased 2PR rate by 67 %; in inpatients, no significant change was demonstrated. Median duration of ED PR decreased from 112 to 71 min (p = 0.006) and ED PR time significantly decreased by 82 % (14.8 to 2.7 h per 1000 h). In the post-implementation period, mean LOS (ED and inpatient) and MMV (ED only) were significantly higher. Fifty-one percent of 494 behavioral alerts were debriefed. Median debriefing duration was 6 min (IQR 4,10). Common themes included cooperation and coordination (23 %) and clinical standards (14 %). DISCUSSION Clinical debriefing implementation was associated with significant improvement in ED patient outcomes. Inpatient outcomes were unchanged, but debriefings in both settings should enable frontline teams to continuously identify opportunities to improve future outcomes.
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Affiliation(s)
- Paul C Mullan
- Children's Hospital of the King's Daughters, Norfolk, VA, United States; Eastern Virginia Medical School, Norfolk, VA, United States.
| | - Andrea D Jennings
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Erin Stricklan
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | | | - Monica Weeks
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Karen Mitchell
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Turaj Vazifedan
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | | | - Daniel B Spencer
- Children's Hospital of the King's Daughters, Norfolk, VA, United States; Eastern Virginia Medical School, Norfolk, VA, United States
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Bijok B, Jaulin F, Picard J, Michelet D, Fuzier R, Arzalier-Daret S, Basquin C, Blanié A, Chauveau L, Cros J, Delmas V, Dupanloup D, Gauss T, Hamada S, Le Guen Y, Lopes T, Robinson N, Vacher A, Valot C, Pasquier P, Blet A. Guidelines on human factors in critical situations 2023. Anaesth Crit Care Pain Med 2023; 42:101262. [PMID: 37290697 DOI: 10.1016/j.accpm.2023.101262] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care. DESIGN A committee of nineteen experts from the SFAR and GFHS learned societies was set up. A policy of declaration of links of interest was applied and respected throughout the guideline-producing process. Likewise, the committee did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based. METHODS We aimed to formulate recommendations according to the GRADE® methodology for four different fields: 1/ communication, 2/ organisation, 3/ working environment and 4/ training. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology. RESULTS The experts' synthesis work and application of the GRADE® method resulted in 21 recommendations. Since the GRADE® method could not be applied in its entirety to all the questions, the guidelines used the SFAR "Recommendations for Professional Practice" A means of secured communication (RPP) format and the recommendations were formulated as expert opinions. CONCLUSION Based on strong agreement between experts, we were able to produce 21 recommendations to guide human factors in critical situations.
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Affiliation(s)
- Benjamin Bijok
- Pôle Anesthésie-Réanimation, Bloc des Urgences/Déchocage, CHU de Lille, Lille, France; Pôle de l'Urgence, Bloc des Urgences/Déchocage, CHU de Lille, Lille, France.
| | - François Jaulin
- Président du Groupe Facteurs Humains en Santé, France; Directeur Général et Cofondateur Patient Safety Database, France; Directeur Général et Cofondateur Safe Team Academy, France.
| | - Julien Picard
- Pôle Anesthésie-Réanimation, Réanimation Chirurgicale Polyvalente - CHU Grenoble Alpes, Grenoble, France; Centre d'Evaluation et Simulation Alpes Recherche (CESAR) - ThEMAS, TIMC, UMR, CNRS 5525, Université Grenoble Alpes, Grenoble, France; Comité Analyse et Maîtrise du Risque (CAMR) de la Société Française d'Anesthésie Réanimation (SFAR), France
| | - Daphné Michelet
- Département d'Anesthésie-Réanimation du CHU de Reims, France; Laboratoire Cognition, Santé, Société - Université Reims-Champagne Ardenne, France
| | - Régis Fuzier
- Unité d'Anesthésiologie, Institut Claudius Regaud. IUCT-Oncopole de Toulouse, France
| | - Ségolène Arzalier-Daret
- Département d'Anesthésie-Réanimation, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000 Caen, France; Comité Vie Professionnelle-Santé au Travail (CVP-ST) de la Société Française d'Anesthésie-Réanimation (SFAR), France
| | - Cédric Basquin
- Département Anesthésie-Réanimation, CHU de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France; CHP Saint-Grégoire, Groupe Vivalto-Santé, 6 Bd de la Boutière CS 56816, 35760 Saint-Grégoire, France
| | - Antonia Blanié
- Département d'Anesthésie-Réanimation Médecine Périopératoire, CHU Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Laboratoire de Formation par la Simulation et l'Image en Médecine et en Santé (LabForSIMS) - Faculté de Médecine Paris Saclay - UR CIAMS - Université Paris Saclay, France
| | - Lucille Chauveau
- Service des Urgences, SMUR et EVASAN, Centre Hospitalier de la Polynésie Française, France; Maison des Sciences de l'Homme du Pacifique, C9FV+855, Puna'auia, Polynésie Française, France
| | - Jérôme Cros
- Service d'Anesthésie et Réanimation, Polyclinique de Limoges Site Emailleurs Colombier, 1 Rue Victor-Schoelcher, 87038 Limoges Cedex 1, France; Membre Co-Fondateur Groupe Facteurs Humains en Santé, France
| | - Véronique Delmas
- Service d'Accueil des Urgences, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; CAp'Sim, Centre d'Apprentissage par la Simulation, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France
| | - Danièle Dupanloup
- IADE, Cadre de Bloc, CHU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France; Comité IADE de la Société Française d'Anesthésie Réanimation (SFAR), France
| | - Tobias Gauss
- Pôle Anesthésie-Réanimation, Bloc des Urgences/Déchocage, CHU Grenoble Alpes, Grenoble, France
| | - Sophie Hamada
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'Anesthésie Réanimation, F-75015, Paris, France; CESP, INSERM U 10-18, Université Paris-Saclay, France
| | - Yann Le Guen
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Thomas Lopes
- Service d'Anesthésie-Réanimation, Hôpital Privé de Versailles, 78000 Versailles, France
| | | | - Anthony Vacher
- Unité Recherche et Expertise Aéromédicales, Institut de Recherche Biomédicale des Armées, Brétigny Sur Orge, France
| | | | - Pierre Pasquier
- 1ère Chefferie du Service de Santé, Villacoublay, France; Département d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France; École du Val-de-Grâce, Paris, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Cancer Research Center of Lyon, Lyon, France
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15
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Bailey CH, Gesch JD. Team Strategies and Dynamics During Resuscitation. Emerg Med Clin North Am 2023; 41:587-600. [PMID: 37391252 DOI: 10.1016/j.emc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Resuscitations are complex events that require teamwork to succeed. In addition to the technical skills involved, a host of nontechnical skills are critical for optimal medical care delivery. These skills include mental preparation; planning for tasks and roles; leadership to guide resuscitation progress; and clear, closed-loop communication. Concerns and error detection should be escalated in an established format. Debriefing after the event helps identify learning points to carry forward for the next resuscitation. Support of the team providing this intense form of care is crucial to protect the mental health and function of providers.
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Affiliation(s)
- Caitlin H Bailey
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Julie D Gesch
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA
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16
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Paquay M, Simon R, Ancion A, Graas G, Ghuysen A. A success story of clinical debriefings: lessons learned to promote impact and sustainability. Front Public Health 2023; 11:1188594. [PMID: 37475771 PMCID: PMC10354544 DOI: 10.3389/fpubh.2023.1188594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
The COVID-19 crisis impacted emergency departments (ED) unexpectedly and exposed teams to major issues within a constantly changing environment. We implemented post-shift clinical debriefings (CDs) from the beginning of the crisis to cope with adaptability needs. As the crisis diminished, clinicians voiced a desire to maintain the post-shift CD program, but it had to be reshaped to succeed over the long term. A strategic committee, which included physician and nurse leadership and engaged front-line staff, designed and oversaw the implementation of CD. The CD structure was brief and followed a debriefing with a good judgment format. The aim of our program was to discover and integrate an organizational learning strategy to promote patient safety, clinicians' wellbeing, and engagement with the post-shift CD as the centerpiece. In this article, we describe how post-shift CD process was performed, lessons learned from its integration into our ED strategy to ensure value and sustainability and suggestions for adapting this process at other institutions. This novel application of debriefing was well received by staff and resulted in discovering multiple areas for improvement ranging from staff interpersonal interactions and team building to hospital wider quality improvement initiatives such as patient throughput.
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Affiliation(s)
- Méryl Paquay
- Emergency Department, University Hospital of Liege Quartier Hôpital, Liege, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| | | | - Aurore Ancion
- Emergency Department, University Hospital of Liege Quartier Hôpital, Liege, Belgium
| | - Gwennaëlle Graas
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital of Liege Quartier Hôpital, Liege, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liege, Belgium
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17
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Dahan M, Lirette MP, Campbell DM, Moga MA. Have you ACED it? How to successfully implement performance-oriented, Acute Critical Event Debriefing. Paediatr Child Health 2023; 28:78-83. [PMID: 37151919 PMCID: PMC10156929 DOI: 10.1093/pch/pxac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Acute Critical Event Debriefing (ACED) after cardiopulmonary arrests should be the standard of care. However, little literature exists on how to implement performance-focused ACED in healthcare. Based on a series of successful ACED implementations in a variety of our settings, we describe key learnings and propose best practices to aid clinicians and organizations in establishing a successful ACED program. Within this practical guide, we also present a novel, standardized debriefing tool (Hotwash) that has been adapted for a variety of clinical settings.
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Affiliation(s)
- Maya Dahan
- Neonatal-Perinatal Fellow, University of Toronto, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marie-Pier Lirette
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Pediatric Emergency Fellow, The Hospital for Sick Children, Toronto, Canada
| | - Douglas M Campbell
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- St. Michael Hospital, Unity Health, Toronto, Canada
| | - Michael-Alice Moga
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
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18
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Hitchner L, Yore M, Burk C, Mason J, Sawtelle Vohra S. The resident experience with psychological safety during interprofessional critical event debriefings. AEM EDUCATION AND TRAINING 2023; 7:e10864. [PMID: 37013133 PMCID: PMC10066498 DOI: 10.1002/aet2.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Interprofessional feedback and teamwork skills training are important in graduate medical education. Critical event debriefing is a unique interprofessional team training opportunity in the emergency department. While potentially educational, these varied, high-stakes events can threaten psychological safety for learners. This is a qualitative study of emergency medicine resident physicians' experience of interprofessional feedback during critical event debriefing to characterize factors that impact their psychological safety. METHODS The authors conduced semistructured interviews with resident physicians who were the physician team leader during a critical event debriefing. Interviews were coded and themes were generated using a general inductive approach and concepts from social ecological theory. RESULTS Eight residents were interviewed. The findings suggest that cultivating a safe learning environment for residents during debriefings involves the following: (1) allowing space for validating statements, (2) supporting strong interprofessional relationships, (3) providing structured opportunities for interprofessional learning, (4) encouraging attendings to model vulnerability, (5) standardizing the process of debriefing, (6) rejecting unprofessional behavior, and (7) creating the time and space for the process in the workplace. CONCLUSIONS Given the numerous intrapersonal, interpersonal, and institutional factors at play, educators should be sensitive to times when a resident cannot engage due to unaddressed threats to their psychological safety. Educators can address these threats in real time and over the course of a resident's training to enhance psychological safety and the potential educational impact of critical event debriefing.
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Affiliation(s)
- Lily Hitchner
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Mackensie Yore
- UCLA National Clinician Scholars Program, Department of Emergency MedicineGreater Los Angeles VA Medical CenterCaliforniaLos AngelesUSA
| | - Charney Burk
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Jessica Mason
- Department of Emergency MedicineJohn Peter Smith HospitalFort WorthTexasUSA
| | - Stacy Sawtelle Vohra
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
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19
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Price K, Cincotta DR, Spencer-Keefe FR, O'Donnell SM. Utilising in situ simulation within translational simulation programmes to evaluate and improve multidisciplinary response to anaphylaxis in the paediatric emergency department. Emerg Med Australas 2023; 35:246-253. [PMID: 36323378 DOI: 10.1111/1742-6723.14107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 03/20/2023]
Abstract
OBJECTIVE The prevalence of paediatric anaphylaxis is rising in Australia. Treatment requires timely administration of intramuscular (IM) adrenaline. Study goals included utilising in situ simulation (ISS) within a translational simulation (TS) programme as a diagnostic tool to identify the frequency and cause of IM adrenaline errors in a paediatric ED, and utilising ISS to evaluate multidisciplinary emergency team response to anaphylaxis. METHODS A prospective observational study was conducted in the Royal Children's Hospital Melbourne ED utilising an ISS anaphylaxis scenario with a debrief pro forma within an established ISS/TS programme. RESULTS Twenty-three anaphylaxis ISS were delivered over 16 months. One hundred and sixty-four multidisciplinary staff participated (mean of 8 per session). Median times (in minutes) for the total ISS were 12:33 (interquartile range [IQR] 9:06-15:19), consisting of the scenario 4:07 (IQR 3:33-4:44) and debriefing 9:00 (IQR 5-11). IM adrenaline was administered in all ISS within 5 min, median 2:57 (IQR 2:30-3:40). Adrenaline medication errors occurred in 30% ISS (7/23). Errors included three (13%) administrations and four (17%) potential or 'near misses' associated with a verbal order or medication preparation error. A weight-based medication cognitive aid was utilised in 56% (13/23) ISS but was not utilised in all three administration errors. CONCLUSIONS ISS within TS programmes was successfully utilised as a diagnostic tool in identifying that medication errors were common during anaphylaxis management in the ED. Improving access to adrenaline in dosing boxes and promoting the utilisation of weight-based cognitive aids alongside ISS education will likely reduce errors and improve patient safety.
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Affiliation(s)
- Kim Price
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Domenic R Cincotta
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Bond Translational Simulation Collaborative, Gold Coast, Queensland, Australia
| | | | - Sinead M O'Donnell
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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20
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Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings. BMJ Qual Saf 2023; 32:160-172. [PMID: 35902231 DOI: 10.1136/bmjqs-2021-014393] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings. METHODS In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection. RESULTS The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. CONCLUSION When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland .,ETH Zürich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland.,Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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21
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The role of debriefing after cardiorespiratory arrest in the pediatric emergency department. Eur J Emerg Med 2023; 30:49-51. [PMID: 36542338 DOI: 10.1097/mej.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Purdy E, Borchert L, El‐Bitar A, Isaacson W, Jones C, Bills L, Brazil V. Psychological safety and emergency department team performance: A mixed‐methods study. Emerg Med Australas 2022; 35:456-465. [PMID: 36519387 DOI: 10.1111/1742-6723.14149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Team culture underpins team performance. Psychological safety - 'a shared belief held by members of a team that the team is safe for interpersonal risk taking' - is a critical component of team culture for high-performing teams across contexts. However, psychological safety in ED teams has not been well explored. We aimed to explore this core teamwork concept in the ED. METHODS This was a sequential mixed-methods study of nursing and medical staff at a large tertiary care ED in Australia from October 2020 to March 2021. First, participants completed the 'Team Learning and Psychological Safety Survey' and a narrative questionnaire. These findings informed semi-structured interviews. We determined median psychological safety and compared results across role and length of time working in the department. Qualitative results were analysed using a deductive thematic analysis using a previously generated framework for enablers of psychological safety at the individual, team and organisational levels. RESULTS The survey was completed by 72/410 participants and 19 interviews were conducted. The median psychological safety score was 37/49 (IQR 13). Psychological safety was not experienced universally, with nurses and new staff experiencing lower levels. Individual, team and organisational factors impacted psychological safety. The primary force shaping psychological safety was familiarity with colleagues and leaders. CONCLUSION Familiarity of team members and leaders was critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams.
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Affiliation(s)
- Eve Purdy
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Laura Borchert
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Anthony El‐Bitar
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Warwick Isaacson
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Cindy Jones
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Lucy Bills
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Victoria Brazil
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
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Impact of the PEARLS Healthcare Debriefing cognitive aid on facilitator cognitive load, workload, and debriefing quality: a pilot study. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:40. [PMID: 36503623 PMCID: PMC9743573 DOI: 10.1186/s41077-022-00236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool is a cognitive aid designed to deploy debriefing in a structured way. The tool has the potential to increase the facilitator's ability to acquire debriefing skills, by breaking down the complexity of debriefing and thereby improving the quality of a novice facilitator's debrief. In this pilot study, we aimed to evaluate the impact of the tool on facilitators' cognitive load, workload, and debriefing quality. METHODS Fourteen fellows from the New York City Health + Hospitals Simulation Fellowship, novice to the PEARLS Healthcare Debriefing Tool, were randomized to two groups of 7. The intervention group was equipped with the cognitive aid while the control group did not use the tool. Both groups had undergone an 8-h debriefing course. The two groups performed debriefings of 3 videoed simulated events and rated the cognitive load and workload of their experience using the Paas-Merriënboer scale and the raw National Aeronautics and Space Administration task load index (NASA-TLX), respectively. The debriefing performances were then rated using the Debriefing Assessment for Simulation in Healthcare (DASH) for debriefing quality. Measures of cognitive load were measured as Paas-Merriënboer scale and compared using Wilcoxon rank-sum tests. Measures of workload and debriefing quality were analyzed using mixed-effect linear regression models. RESULTS Those who used the tool had significantly lower median scores in cognitive load in 2 out of the 3 debriefings (median score with tool vs no tool: scenario A 6 vs 6, p=0.1331; scenario B: 5 vs 6, p=0.043; and scenario C: 5 vs 7, p=0.031). No difference was detected in the tool effectiveness in decreasing composite score of workload demands (mean difference in average NASA-TLX -4.5, 95%CI -16.5 to 7.0, p=0.456) or improving composite scores of debriefing qualities (mean difference in DASH 2.4, 95%CI -3.4 to 8.1, p=0.436). CONCLUSIONS The PEARLS Healthcare Debriefing Tool may serve as an educational adjunct for debriefing skill acquisition. The use of a debriefing cognitive aid may decrease the cognitive load of debriefing but did not suggest an impact on the workload or quality of debriefing in novice debriefers. Further research is recommended to study the efficacy of the cognitive aid beyond this pilot; however, the design of this research may serve as a model for future exploration of the quality of debriefing.
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Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical event debriefing program and a novel qualitative model to analyze debriefing content. Adv Simul (Lond) 2022; 7:36. [PMID: 36303254 PMCID: PMC9612619 DOI: 10.1186/s41077-022-00226-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare workers faced unique challenges during the early months of the COVID-19 pandemic which necessitated rapid adaptation. Clinical event debriefings (CEDs) are one tool that teams can use to reflect after events and identify opportunities for improving their performance and their processes. There are few reports of how teams have used CEDs in the COVID-19 pandemic. Our aim is to explore the issues discussed during COVID-19 CEDs and propose a framework model for qualitatively analyzing CEDs. Methods This was a descriptive, qualitative study of a hospital-wide CED program at a quaternary children’s hospital between March and July 2020. CEDs were in-person, team-led, voluntary, scripted sessions using the Debriefing in Suspected COVID-19 to Encourage Reflection and Team Learning (DISCOVER-TooL). Debriefing content was qualitatively analyzed using constant comparative coding with an integrated deductive and inductive approach. A novel conceptual framework was proposed for understanding how debriefing content can be employed at various levels in a health system for learning and improvement. Results Thirty-one debriefings were performed and analyzed. Debriefings had a median of 7 debriefing participants, lasted a median of 10 min, and were associated with multiple systems-based process improvements. Fourteen themes and 25 subthemes were identified and categorized into a novel Input-Mediator-Output-Input Debriefing (IMOID) model. The most common themes included communication, coordination, situational awareness, team member roles, and clinical standards. Conclusions Teams identified diverse issues in their debriefing discussions related to areas of high performance and opportunities for improvement in their care of COVID-19 patients. This model may help healthcare systems to understand how CED tools can be used to accelerate organizational learning to promote safety and improve outcomes in changing clinical environments. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-022-00226-z.
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Kanaris C, Murphy PC. Fifteen-minute consultation: Intubation of the critically ill child presenting to the emergency department. Arch Dis Child Educ Pract Ed 2022; 107:330-337. [PMID: 34413121 DOI: 10.1136/archdischild-2021-322520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 11/04/2022]
Abstract
Intubation of critically ill children presenting to the emergency department is a high-risk procedure. Our article aims to offer a step-by-step guide as to how to plan and execute a rapid, successful intubation in a way that minimises risk of adverse events and patient harm. We address considerations such as the need for adequate resuscitation before intubation and selection of equipment and personnel. We also discuss drug choice for induction and peri-intubation instability, difficult airway considerations as well as postintubation care. Focus is also given on the value of preintubation checklists, both in terms of equipment selection and in the context of staff role designation and intubation plan clarity. Finally, in cases of failed intubation, we recommend the application of the Vortex approach, highlighting, thus, the importance of avoiding task fixation and maintaining our focus on what matters most: adequate oxygenation.
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Affiliation(s)
- Constantinos Kanaris
- Department of Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK .,Blizard Institute, Queen Mary University of London, London, UK
| | - Peter Croston Murphy
- Department of Paediatric Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK.,North West and North Wales Paediatric Transport Service, Royal Manchester Children's Hospital, Manchester, UK
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van Dalen ASHM, Jung JJ, Nieveen van Dijkum EJM, Buskens CJ, Grantcharov TP, Bemelman WA, Schijven MP. Analyzing and Discussing Human Factors Affecting Surgical Patient Safety Using Innovative Technology: Creating a Safer Operating Culture. J Patient Saf 2022; 18:617-623. [PMID: 35985043 DOI: 10.1097/pts.0000000000000975] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Surgical errors often occur because of human factor-related issues. A medical data recorder (MDR) may be used to analyze human factors in the operating room. The aims of this study were to assess intraoperative safety threats and resilience support events by using an MDR and to identify frequently discussed safety and quality improvement issues during structured postoperative multidisciplinary debriefings using the MDR outcome report. METHODS In a cross-sectional study, 35 standard laparoscopic procedures were performed and recorded using the MDR. Outcome data were analyzed using the automated Systems Engineering Initiative for Patient Safety model. The video-assisted MDR outcome report reflects on safety threat and resilience support events (categories: person, tasks, tools and technology, psychical and external environment, and organization). Surgeries were debriefed by the entire team using this report. Qualitative data analysis was used to evaluate the debriefings. RESULTS A mean (SD) of 52.5 (15.0) relevant events were identified per surgery. Both resilience support and safety threat events were most often related to the interaction between persons (272 of 360 versus 279 of 400). During the debriefings, communication failures (also category person) were the main topic of discussion. CONCLUSIONS Patient safety threats identified by the MDR and discussed by the operating room team were most frequently related to communication, teamwork, and situational awareness. To create an even safer operating culture, educational and quality improvement initiatives should aim at training the entire operating team, as it contributes to a shared mental model of relevant safety issues.
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Affiliation(s)
| | - James J Jung
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | | | - Christianne J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Willem A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Davies JA. Supporting children's nurses to deliver trauma-informed care. Nurs Child Young People 2022; 35:e1422. [PMID: 35938421 DOI: 10.7748/ncyp.2022.e1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/09/2022]
Abstract
World events, such as the conflict in Ukraine, the humanitarian crisis in Afghanistan and the coronavirus disease 2019 pandemic, have highlighted the effects of trauma and adverse childhood experiences on children and young people. Adverse childhood experiences can lead to suboptimal health and risk-taking behaviours during adolescence and adulthood, while multiple adverse childhood experiences can manifest as complex trauma, toxic stress, anxiety or depression across a person's lifespan. This article discusses adverse childhood experiences and the concept of trauma-informed care, which involves recognising and understanding the negative events that have affected a person and how these relate to suboptimal health. The author suggests that developing resilience and using self-care strategies can support nurses to adopt a trauma-informed approach to care. This can assist them to recognise, understand and reflect on the effects of adverse childhood experiences in themselves as well as in their patients. The author also outlines a hybrid approach to debrief that can support staff to manage stressful situations and challenging workplace experiences.
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McGhee I, Tarshis J, DeSousa S. Improving Ad Hoc Medical Team Performance with an Innovative "I START-END" Communication Tool. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:809-820. [PMID: 35959135 PMCID: PMC9359176 DOI: 10.2147/amep.s367973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To study the effect of a communication tool entitled: "I START-END" (I-Identify; S-Story; T-Task; A-Accomplish/Adjust; R-Resources; T-Timely Updates; E-Exit; N-Next; D-Document and Debrief) in simulated urgent scenarios in non-operating room settings (referred to as "Ad Hoc") with anesthesia residents. The "I START-END" tool was created by incorporating Crisis Resource Management (CRM) principles into a practical and user-friendly format. METHODS This was a mixed methods pre/post observational study with 47 anesthesia resident volunteers participating from July 2014 to June 2016. Each resident served as their own control, and participated in three simulated Ad Hoc scenarios. The first simulation served as a baseline. The second simulation occurred 1-2 weeks after I START-END training. The third simulation occurred 3-6 months later. Simulation performance was videotaped and reviewed by trained experts using technical skill checklists and Anesthesia Non-Technical Skills (ANTS) score. Residents filled out questionnaires, pre-simulation, 1-2 weeks after I START-END training and 3-6 months later. Concurrently, resident performance at actual Code Blue events was scored by trained observers using the Mayo High Performance Teamwork Scale. RESULTS 80-90% of residents stated the tool provided an organized approach to Ad Hoc scenarios - specifically, information helpful to care of the patient was obtained more readily and better resource planning occurred as communication with the team improved. Residents stated they would continue to use the tool and apply it to other clinical settings. Resident video performance scores of technical skills showed significant improvement at the "late" session (3-6 months post exposure to the I START-END). ANTS scores were satisfactory and remained unchanged throughout. There was no difference between residents with and without I START-END training as measured by the Mayo High Performance Teamwork Scale, however, debriefing at Code Blues occurred twice as often when residents had I START-END training. CONCLUSION Non-operating room settings are fraught with unfamiliarity that create many challenges. The I START-END tool operationalizes key CRM elements. The tool was well received by residents; it enabled them to speak up more readily, obtain vital information and continually update each other by anticipating, planning, and debriefing in an organized and collaborative way.
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Affiliation(s)
- Irene McGhee
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan Tarshis
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan DeSousa
- Sunnybrook Canadian Simulation Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Mohd Kamaruzaman AZ, Ibrahim MI, Mokhtar AM, Mohd Zain M, Satiman SN, Yaacob NM. The Effect of Second-Victim-Related Distress and Support on Work-Related Outcomes in Tertiary Care Hospitals in Kelantan, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6454. [PMID: 35682042 PMCID: PMC9180130 DOI: 10.3390/ijerph19116454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
After a patient safety incident, the involved healthcare providers may experience sustained second-victim distress and reduced professional efficacy, with subsequent negative work-related outcomes and the cultivation of resilience. This study aims to investigate the factors affecting negative work-related outcomes and resilience with a hypothetical triad of support as the mediators: colleague, supervisor, and institutional support. This cross-sectional study recruited 733 healthcare providers from three tertiary care hospitals in Kelantan, Malaysia. Three steps of hierarchical linear regression were developed for both outcomes (negative work-related outcomes and resilience). Four multiple mediator models of the support triad were analyzed. Second-victim distress, professional efficacy, and the support triad contributed significantly in all the regression models. Colleague support partially mediated the relationship defining the effects of professional efficacy on negative work-related outcomes and resilience, whereas colleague and supervisor support partially mediated the effects of second-victim distress on negative work-related outcomes. Similar results were found regarding resilience, with all support triads producing similar results. As mediators, the support triads ameliorated the effect of second-victim distress on negative work-related outcomes and resilience, suggesting an important role of having good support, especially after encountering patient safety incidents.
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Affiliation(s)
- Ahmad Zulfahmi Mohd Kamaruzaman
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Ariffin Marzuki Mokhtar
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
| | - Maizun Mohd Zain
- Public Health Unit, Hospital Raja Perempuan Zainab II, Kota Bharu 16150, Kelantan, Malaysia;
| | - Saiful Nazri Satiman
- Medical Division, Kelantan State Health Department, Kota Bharu 16150, Kelantan, Malaysia;
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia;
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Gabriel PM, Smith K, Mullen-Fortino M, Ballinghoff J, Holland S, Cacchione PZ. Systematic Debriefing for Critical Events Facilitates Team Dynamics, Education, and Process Improvement. J Nurs Care Qual 2022; 37:142-148. [PMID: 34231505 DOI: 10.1097/ncq.0000000000000581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Debriefing is used in clinical settings to support interprofessional staff, improve processes, and identify educational needs. Nurses who lead debriefing sessions are empowered to improve processes. PROBLEM Nurse leaders identified the need for debriefing outside the critical care areas due to the rising acuity levels. APPROACH Two nurse leaders developed a debriefing initiative in one urban teaching hospital following rapid responses, codes, and stressful situations. Nurses developed a Debriefing Facilitation Guide to collect qualitative aspects of clinical emergencies to improve processes, education, and team dynamics. OUTCOMES Following each debriefing session, we deductively purposively coded the qualitative data into 3 a priori themes: the American Heart Association's team dynamics, process improvement, and educational opportunities. We identified opportunities for improvement for these themes during our first 54 debriefing sessions. CONCLUSIONS Following each debriefing session, the debriefing nurse leader intervened on all educational and process improvement opportunities identified and facilitated positive team dynamics.
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Affiliation(s)
- Paula M Gabriel
- Penn Presbyterian Medical Center, Philadelphia, Pennsylvania (Mss Gabriel and Smith and Drs Mullen-Fortino, Ballinghoff, and Cacchione); University of Pennsylvania School of Nursing, Philadelphia (Dr Cacchione); Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Cacchione); and Department of Medicine, Penn Medicine Clinical Effectiveness and Quality Improvement, Philadelphia, Pennsylvania (Dr Holland)
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Eaton PL, Mullan PC, Papa L, Chen JG, Cramm K, Buning B, Vazifedan T, Zinns LE. Evaluation of an Online Educational Tool to Improve Postresuscitation Debriefing in the Emergency Department. Pediatr Emerg Care 2021; 37:e1233-e1238. [PMID: 32011557 DOI: 10.1097/pec.0000000000001982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Postresuscitation debriefing (PRD) addresses Accreditation Council for Graduate Medical Education core competencies and is recommended by the American Heart Association. Postresuscitation debriefing improves resuscitation outcomes, promotes team morale, supports emotional well-being, and reduces burnout. Despite these benefits, PRD occurs infrequently. Commonly cited barriers to PRD include lack of training and comfort in facilitating PRD. We are unaware of any video-based educational tools that train physicians in PRD. We aimed to evaluate the impact of an educational tool on the frequency of PRD using a before- and after-study design. METHODS We created and distributed a 20-minute, video-based educational tool via youtube.com on PRD to pediatric emergency medicine (EM) fellows, pediatric EM attendings, senior EM residents, and EM attending physicians. Participants completed web-based surveys before, immediately after, and 3 months after watching the tool. We analyzed the effects of participation on PRD knowledge, comfort conducting PRD, and frequency of PRD performance. RESULTS Thirty-five (63%) of 56 participants completed all 3 surveys. Participation in our study showed significant improvements in reported frequency of performing PRD (23% presurvey, 38% follow-up survey; 95% confidence interval [CI], 2%-29%; P = 0.03), perceived knowledge of PRD (odds ratio, 6.1; 95% CI, 3.05-12.29; P < 0.001), and comfort in conducting PRD (odds ratio, 3.7; 95% CI, 1.96-7.03; P < 0.001). Most respondents (94%) reported that the tool was worthwhile. Most (83%) would recommend the tool to colleagues, and 86% reported positive effects on their teams with PRD. CONCLUSIONS Implementation of a video-based educational tool on PRD in the emergency department was associated with increased provider report of PRD frequency, knowledge, and comfort level.
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Affiliation(s)
- Patricia L Eaton
- From the Pediatric Emergency Department, Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando, FL
| | - Paul C Mullan
- Pediatric Emergency Department, Children's Hospital of the King's Daughters, Norfolk, VA
| | - Linda Papa
- Emergency Medicine Department, Academic Clinical Research for Orlando Health
| | | | - Kelly Cramm
- Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando, FL
| | | | - Tuzraj Vazifedan
- Division of Biostatistics, Children's Hospital of The King's Daughters, Norfolk, VA
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Delany C, Jones S, Sokol J, Gillam L, Prentice T. Reflecting Before, During, and After the Heat of the Moment: A Review of Four Approaches for Supporting Health Staff to Manage Stressful Events. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:573-587. [PMID: 34741699 DOI: 10.1007/s11673-021-10140-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children's hospital and more broadly from the literature to identify and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation.
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Affiliation(s)
- C Delany
- Children's Bioethics Centre, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia.
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia.
| | - S Jones
- Affiliate of Social Work Department, Royal Children's Hospital and Private Practice, 124 Jolimont Road, Victoria, 3002, East Melbourne, Australia
| | - J Sokol
- Department of Medical Education, Head of Simulation, Royal Children's Hospital. , Department of Paediatrics, University of Melbourne , 50 Flemington Rd, Parkville, Victoria, 3052, Australia
| | - L Gillam
- Children's Bioethics Centre, Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria, 3052, Australia
- Children's Bioethics Centre, Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - T Prentice
- Newborn Intensive Care, Royal Children's Hospital, Dept of Paediatrics, University of Melbourne, Honorary Research Fellow, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, Victoria, 3052, Australia
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Arriaga AF, Chen YYK, Pimentel MPT, Bader AM, Szyld D. Critical event debriefing: a checklist for the aftermath. Curr Opin Anaesthesiol 2021; 34:744-751. [PMID: 34817451 DOI: 10.1097/aco.0000000000001061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Millions of perioperative crises (e.g. anaphylaxis, cardiac arrest) may occur annually. Critical event debriefing can offer benefits to the individual, team, and system, yet only a fraction of perioperative critical events are debriefed in real-time. This publication aims to review evidence-based best practices for proximal critical event debriefing. RECENT FINDINGS Evidence-based key processes to consider for proximal critical event debriefing can be summarized by the WATER mnemonic: Welfare check (assessing team members' emotional and physical wellbeing to continue providing care); Acute/short-term corrections (matters to be addressed before the next case); Team reactions and reflections (summarizing case; listening to team member reactions; plus/delta conversation); Education (lessons learned from the event and debriefing); Resource awareness and longer term needs [follow-up (e.g. safety/quality improvement report), local peer-support and employee assistance resources]. A cognitive aid to accompany this mnemonic is provided with the publication. SUMMARY There is growing literature on how to conduct proximal perioperative critical event debriefing. Evidence-based best practices, as well as a cognitive aid to apply them, may help bridge the gap between theory and clinical practice. In this era of increased attention to burnout and wellness, the consideration of interventions to improve the quality and frequency of critical event debriefing is paramount.
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Affiliation(s)
- Alexander F Arriaga
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
- Center for Surgery and Public Health
- Ariadne Labs
| | - Yun-Yun K Chen
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
| | - Marc Philip T Pimentel
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
| | - Angela M Bader
- Harvard Medical School
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital
- Center for Surgery and Public Health
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital
- Center for Medical Simulation, Boston, Massachusetts, USA
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Mullan PC, Zinns LE, Cheng A. Debriefing the Debriefings: Caring for Our Patients and Caring for Ourselves. Hosp Pediatr 2021; 11:hpeds.2021-006339. [PMID: 34807984 DOI: 10.1542/hpeds.2021-006339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Paul C Mullan
- Division of Emergency Medicine, Children's Hospital of the King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia
| | - Lauren E Zinns
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Cheng
- Alberta Children's Hospital and Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Galligan MM, Haggerty M, Wolfe HA, Debrocco D, Kellom K, Garcia SM, Neergaard R, Akpek E, Barg FK, Friedlaender E. From the Frontlines: A Qualitative Study of Staff Experiences With Clinical Event Debriefing. Hosp Pediatr 2021; 11:hpeds.2021-006088. [PMID: 34808664 DOI: 10.1542/hpeds.2021-006088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program. METHODS We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week. We explored experiences with CED, with a focus on barriers and facilitators. We used content analysis with constant comparative coding to understand priorities identified by participants. We used inductive reasoning to develop a set of CED practice recommendations to match participant priorities. RESULTS Three primary themes emerged related to CED barriers and facilitators. (1) Factors affecting attendance: most respondents voiced a need for frontline staff inclusion in CED, but they also cited competing clinical duties and scheduling conflicts as barriers. (2) Factors affecting participant engagement: respondents described factors that influence participant engagement in reflective discussion. They described that the CED leader must cultivate a psychologically safe environment in which participants feel empowered to speak up, free from judgment. (3) Factors affecting learning and systems improvement: respondents emphasized that the CED group should generate a plan for improvement with accountable stakeholders. Collectively, these priorities propose several recommendations for CED practice, including frontline staff inclusion. CONCLUSIONS In this study, we propose recommendations for CED that are derived from first-hand participant experiences. Future study will explore implementation of CED practice recommendations.
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Affiliation(s)
- Meghan M Galligan
- Departments of Pediatrics
- The Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Heather A Wolfe
- Anesthesiology and Critical Care Medicine
- The Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Katherine Kellom
- Policy Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie M Garcia
- Policy Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Neergaard
- Family Medicine and Community Health, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eda Akpek
- Family Medicine and Community Health, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frances K Barg
- Family Medicine and Community Health, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sillitoe K, Kimbya N, Milliken J, Bennett P. Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care. ACTA ACUST UNITED AC 2021; 30:1132-1139. [PMID: 34723662 DOI: 10.12968/bjon.2021.30.19.1132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED). AIM A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service. METHOD Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis. FINDINGS This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure. CONCLUSION PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.
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Affiliation(s)
- Kristina Sillitoe
- Senior Sister Emergency Medicine, Countess of Chester Hospital NHS Trust
| | - Nikki Kimbya
- Clinical Psychologist in Psychological Trauma, Senior Lecturer and Programme Leader MSc Therapeutic Practice for Psychological Trauma, Chester University
| | - Jackie Milliken
- Trauma Co-ordinator and Senior Sister Emergency Medicine, Countess of Chester Hospital NHS Trust
| | - Paula Bennett
- Associate Director Clinical Development, Utilisation Management Unit-Health Innovation Manchester
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Brazil V, Symon B, Twigg S. Clinical debriefing in the emergency department. Emerg Med Australas 2021; 33:778-779. [PMID: 34535044 DOI: 10.1111/1742-6723.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ben Symon
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sonia Twigg
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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Alshyyab MA, FitzGerald G, Albsoul RA, Ting J, Kinnear FB, Borkoles E. Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study. Int J Health Plann Manage 2021; 36:2392-2410. [PMID: 34476834 DOI: 10.1002/hpm.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. METHODS A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. RESULTS Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. CONCLUSIONS This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard FitzGerald
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joseph Ting
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Erika Borkoles
- Department of Public Health, School of Medicine, Public Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Brazil V, Williams J. How to lead a hot debrief in the emergency department. Emerg Med Australas 2021; 33:925-927. [PMID: 34467666 DOI: 10.1111/1742-6723.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria Brazil
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Emergency Department, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Jennifer Williams
- Emergency Department, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,Griffith University School of Medicine, Gold Coast, Queensland, Australia
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The Effect of Psychological Hotwash on Resilience of Emergency Medical Services Personnel. Emerg Med Int 2021; 2021:4392996. [PMID: 34462669 PMCID: PMC8403047 DOI: 10.1155/2021/4392996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/23/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency medical services (EMS) personnel are exposed to stress. Job stress in EMS personnel can reduce their resilience and have adverse effects on their clinical performance and mental health, thus reducing the quality of their work. The present research was performed to determine the effect of psychological hotwash on resilience of emergency medical services personnel. Methods This study was a quasiexperimental. Sixty-four EMS personnel were randomly divided into two groups of hotwash and control. The psychological hotwash program was performed in the intervention group for a month based on the protocol; however, the control group continued their usual work and received no intervention. A day and six weeks after the psychological hotwash in the intervention group, the resilience of the EMS personnel was remeasured in both groups. Results Before the intervention, the participants' mean resilience score was 138.37 ± 7.04 in the intervention group and 137.34 ± 8.48 in the control group. There was a statistically significant difference between the mean scores of resilience in the intervention and control groups a day after the intervention (P=0.003). There was no statistically significant difference between the mean scores of resilience in the intervention and control groups 6 weeks after the intervention (P=0.102). Conclusion The EMS personnel's attendance at psychological hotwash sessions could increase their resilience. Nevertheless, the sessions should not be interrupted because the 6-week interruption of the sessions caused the nonsignificant scores of resilience in the hotwash and control groups. Hence, it is recommended to continue the investigation of the effects of hotwash on resilience, stress reduction, and job burnout reduction in EMS personnel by other researchers in different settings.
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Dubash R, Govindasamy LS, Bertenshaw C, Ho JH. Debriefing in the emergency department. Emerg Med Australas 2021; 33:922-924. [PMID: 34463044 DOI: 10.1111/1742-6723.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Roxanne Dubash
- Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Claire Bertenshaw
- Queensland Ambulance Service, Brisbane, Queensland, Australia.,Emergency Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia
| | - James H Ho
- Emergency Department, Austin Health, Melbourne, Victoria, Australia.,Emergency Department, Cabrini Health, Melbourne, Victoria, Australia
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42
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Page J. Hot emergency department debrief: A trainee's perspective. Emerg Med Australas 2021; 33:930-931. [PMID: 34453410 DOI: 10.1111/1742-6723.13858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Page
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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43
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Timothy CL, Brown AJ, Thomas EK. Implementation of a postarrest debriefing tool in a veterinary university hospital. J Vet Emerg Crit Care (San Antonio) 2021; 31:718-726. [PMID: 34432941 DOI: 10.1111/vec.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/04/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of a postarrest debriefing tool (DBT) within a university teaching hospital and to evaluate user perceptions of the tool. DESIGN Observational study over a 1-year period and associated hospital clinical personnel survey. SETTING University teaching hospital. INTERVENTIONS Qualitative data surrounding the use and utility of the DBT were analyzed, as well as survey results. MEASUREMENTS AND MAIN RESULTS Forty-four arrests occurred during the study period. Debriefing was performed after 26 of 44 (59%) cardiopulmonary resuscitation (CPR) events, of which 22 of 26 (85%) were recorded using the DBT and four without the DBT. Return of spontaneous circulation did not significantly affect the use of the DBT (p = 0.753). Most events in which debriefing was not performed occurred outside of business hours (13/18; 72%). The most frequent positive debriefing comments related to cooperation/coordination within the team (22/167; 13%). The most frequent negative debriefing comments concerned equipment issues (36/167; 22%). Of the action points generated, 57% (34/60) were directed at equipment use/availability. Teams reported that emergency drugs were appropriately administered in 21 of 22 (95%) cases. In contrast, closed loop communication was reportedly only used during 6 of 22 (27%) events. The hospital survey response rate was 56 of 338 (17%) clinical staff, of whom 37 of 56 (66%) agreed or strongly agreed that debriefing had improved team performance during CPR. Overall, 33 of 56 (60%) staff felt that the DBT had improved the debriefing process at the hospital. However, 3 of 56 (5%) staff members felt that they were unable to state their opinions in a blame-free environment during debriefing. CONCLUSIONS Implementation of a DBT enabled formal identification of strengths and training needs of resuscitation teams, and its implementation was viewed positively by the majority of hospital staff. However, further refinement of the tool and prospective studies evaluating its efficacy in improving outcome are warranted.
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Affiliation(s)
- Clare L Timothy
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Andrew J Brown
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Emily K Thomas
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
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Chu J, Alawa N, Sampayo EM, Doughty C, Camp E, Welch‐Horan TB. Evolution of clinical event debriefs in a quaternary pediatric emergency department after implementation of a debriefing tool. AEM EDUCATION AND TRAINING 2021; 5:e10709. [PMID: 34901688 PMCID: PMC8637867 DOI: 10.1002/aet2.10709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Debriefing clinical events in the emergency department (ED) can enhance team performance and provide mutual support. However, ED debriefing remains infrequent and nonstandardized. A clinical tool (DISCERN-Debriefing In Situ Conversation after Emergent Resuscitation Now) was developed to facilitate ED debriefing. To date, there are no studies providing qualitative analysis of clinical event debriefs done using such a tool. Our goal was to explore common themes elicited by debriefing following implementation of DISCERN. METHODS This was a retrospective mixed-methods study analyzing DISCERN data from 2012 through 2017 in a pediatric ED. Quantitative data were analyzed using descriptive statistics. With constant comparison analysis, themes were categorized when applicable within the context of crisis resource management (CRM) principles, previously used as a framework for description of nontechnical skills. Member checking was performed to ensure trustworthiness. RESULTS We reviewed 400 DISCERN forms. Overall, 170 (41.6%) of target clinical events were debriefed during the study period. The number of clinical events debriefed per year decreased significantly over the study period, from 118 debriefed events in 2013 to 20 debriefed events in 2017 (p < 0.001). Events were more likely to be debriefed if cardiopulmonary resuscitation was needed (odds ratio [OR] = 11.8, 95% confidence interval [CI] = 4.1-33.8]) or if the patient expired (OR = 8.9, 95% CI = 2.7-29.1]). CRM principles accounted for 81% of debriefing statements, focusing on teamwork, communication, and preparation, and these themes remained consistent throughout the study period. CONCLUSIONS Use of the DISCERN tool declined over the study period. The DISCERN tool was utilized more commonly after the highest-acuity events. Clinical event debriefs aligned with CRM principles, with medical knowledge discussed less frequently, and the content of debriefs remained stable over time.
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Affiliation(s)
- Jamie Chu
- Texas Children's HospitalBaylor College of MedicineHoustonTexasUSA
- Present address:
McGovern Medical SchoolUT HealthHoustonTexasUSA
| | - Nawara Alawa
- Texas Children's HospitalBaylor College of MedicineHoustonTexasUSA
- Present address:
Boston Children's HospitalBostonMassachusettsUSA
| | | | - Cara Doughty
- Texas Children's HospitalBaylor College of MedicineHoustonTexasUSA
| | - Elizabeth Camp
- Texas Children's HospitalBaylor College of MedicineHoustonTexasUSA
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Ali Y, Fraser D. Debriefing: A Tool to Enhance Education and Practice in NICU. Neonatal Netw 2021; 40:321-331. [PMID: 34518384 DOI: 10.1891/11-t-698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
Debriefing, a facilitator-guided reflection of an educational experience or critical incident, is an important tool in improving the safety and quality of practice in the NICU. Unlike feedback, which is often a one-way discussion, debriefing is a purposeful, 2-way reflective discussion which is based on experiential learning theory. The purpose of this article is to review the theoretical basis of debriefing and describe styles and tools for debriefing that can be applied in the NICU.
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46
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Lyman K. The relationship between post-resuscitation debriefings and perceptions of teamwork in emergency department nurses. Int Emerg Nurs 2021; 57:101005. [PMID: 34252748 DOI: 10.1016/j.ienj.2021.101005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emergency department nurses are faced with traumatic patient events while functioning as members of multidisciplinary teams. Postresuscitation debriefings have been shown to benefit health care professionals and patient clinical outcomes. The purpose of this study was to examine the relationship between the use of post resuscitation debriefings and perceptions of teamwork in emergency department nurses. The study also addressed the type and timing of debriefing to determine whether these factors are associated with perceptions of teamwork. METHODS A nationwide survey was disseminated to emergency department nurses throughout the United States. The design aimed to compare the results from the Nursing Teamwork Survey with the data regarding frequency, type, and timing of debriefings. An ANOVA and Scheffe post hoc was done as well. RESULTS The 68 responses which were included in the data were from 27 different states. Results showed that when debriefings were done more frequently (η = .41, p = .02), were conducted using a formal debriefing method (η = .36, p = .01), and were held immediately after a situation (η = .36, p = .03), there was a significant positive relationship (eta coefficient) with higher levels of trust, team orientation, backup, shared mental model, and leadership. CONCLUSION Findings may be used to increase utilization of debriefings and improve perceptions of teamwork among emergency department nurses.
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Cincotta DR, Quinn N, Grindlay J, Sabato S, Fauteux-Lamarre E, Beckerman D, Carroll T, Long E. Debriefing immediately after intubation in a children's emergency department is feasible and contributes to measurable improvements in patient safety. Emerg Med Australas 2021; 33:780-787. [PMID: 34247438 DOI: 10.1111/1742-6723.13813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In 2013, our intubations highlighted a safety gap - only 49% achieved first-pass success without hypoxia or hypotension. NAP4 recommended debriefing after intubation, but limited published methods existed. Primary aim is to implement a feasible process for immediate debriefing and feedback for emergency airway management. Secondary aims are to contribute to reduced frequency of adverse intubation-related events and implement qualitative improvements in patient safety through team reflection and feedback. METHODS A component of a prospective quality improvement (QI) study over 4 years in the ED of the Royal Children's Hospital, Melbourne, Australia. Debrief and feedback after intubation was one of seven study interventions. Targeted staff training and involvement of departmental leaders occurred. A post-intervention cohort was audited in 2016. Analysis included the Team Emergency Assessment Measure. RESULTS Immediate post-event debriefing occurred in 39 (85%) of 46 intubations. Debriefing was short (median duration 5 min, interquartile range [IQR] 5-10) and soon after (median time 20 min, IQR 5-60). Commonest location was the resuscitation room (92%), led by the team leader (97%). Commonest barrier preventing immediate debriefing was excessive workload. Two QI process measures were assessed during debriefing (adequate resuscitation, airway plan) and case summaries distributed for 100% of intubations. Performance outcomes included contribution to 78% first-pass success without hypoxia or hypotension. Team reflection prompted changes to environment (signage, stickers), training (skill drills), teamwork and process (communication, clinical event debriefing). CONCLUSION Structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety.
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Affiliation(s)
- Domenic R Cincotta
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nuala Quinn
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joanne Grindlay
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stefano Sabato
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - David Beckerman
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Terry Carroll
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine and Radiology, Centre for Integrated Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
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Tyler SP, Dixon J, Parkosewich J, Mullan PC, Aghera A. Development, Validation, and Implementation of a Guideline to Improve Clinical Event Debriefing at a Level-I Adult and Level-II Pediatric Trauma Center. J Emerg Nurs 2021; 47:707-720. [PMID: 34217519 DOI: 10.1016/j.jen.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinical event debriefing is recommended by the American Heart Association and the European Resuscitation Council, because debriefings improve team performance. The purpose here was to develop and validate tools needed to overcome barriers to debriefing in the emergency department. METHOD This quality improvement project was conducted in 4 phases. Phase 1: Current evidence related to debriefing in the emergency department was reviewed and synthesized to inform an iterative process for drafting the debriefing guideline and instrument for documentation. Phase 2: Content Validity Index of the tools was evaluated by obtaining ratings of items' clarity and relevance from 5 national experts in 2 rounds of review. On the basis of experts' feedback, tools were revised, and a Facilitators' Guide was created. Phase 3: The validated debriefing tools were implemented. Phase 4: Debriefing facilitators completed a survey about their experience with using the new tools. RESULTS The Content Validity Index of 71 debriefing tool items (guideline, instrument, Facilitators' Guide) was 0.93 and 0.96 for clarity and relevance, respectively. Of the 32 debriefings conducted during the first 8 weeks of implementation, 53% described patient safety concerns, and 97% described recommendations to improve performance. Most (94%) facilitators agreed that the guideline clarified debriefing requirements. CONCLUSION The use of debriefing tools validated by computation of the Content Validity Index led to the identification of safety threats and recommendations to improve care processes. These tools can be used in ED settings to promote team learning and aid in identifying and resolving safety concerns.
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Gilmartin S, Martin L, Kenny S, Callanan I, Salter N. Promoting hot debriefing in an emergency department. BMJ Open Qual 2021; 9:bmjoq-2020-000913. [PMID: 32816864 PMCID: PMC7430325 DOI: 10.1136/bmjoq-2020-000913] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Debriefing is a process of communication that takes place between a team following a clinical case. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence as well as potential errors made. This helps to develop plans to improve subsequent performance. While the American Heart Association and the UK Resuscitation Council recommend debriefing following every cardiac arrest attended by a healthcare professional, it has not become part of everyday practice. In the emergency department (ED), this is in part attributable to time pressures and workload. Hot debriefing is a form of debriefing which should occur 'there and then' following a clinical event. The aim of this quality improvement project was to introduce hot debriefing to our ED following all cardiac arrests. METHODS A hot debriefing tool was designed following simulated cardiac arrest scenarios and team feedback. This tool was then introduced to the ED for use after all cardiac arrests. The team lead was asked to complete a debrief form. These completed hot debrief forms were collated monthly and compared with the department's cardiac arrest register. Any changes made to cardiac arrest management following hot debriefing were recorded. Qualitative feedback was obtained through questionnaires. RESULTS During the 6-month study period, 42% of all cardiac arrest cases were followed by a hot debrief. Practice changes were made to resus room equipment, practitioners' non-technical skills and the department's educational activities. 95% of participants felt the hot debriefing tool was of 'just right' duration, 100% felt the process helped with their clinical practice, and 90% felt they benefited psychologically from the process. CONCLUSION The introduction of a hot debriefing tool in our department has led to real-world changes to cardiac arrest care. The process benefits participants' clinical practice as well as psychological well-being.
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Affiliation(s)
- Stephen Gilmartin
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
| | - Laura Martin
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
| | - Siobhain Kenny
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
| | - Ian Callanan
- Clinical Audit, St Vincent's University Hospital, Dublin, Ireland
| | - Nigel Salter
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. [Education for resuscitation]. Notf Rett Med 2021; 24:750-772. [PMID: 34093075 PMCID: PMC8170459 DOI: 10.1007/s10049-021-00890-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.
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Affiliation(s)
- Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Schweiz.,School of Medicine, Sigmund Freud University Vienna, Wien, Österreich
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, Großbritannien
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zürich, Schweiz
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Großbritannien
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal research and clinical center of intensive care medicine and Rehabilitology, Moskau, Russland
| | - Lucas Pflanzl-Knizacek
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Skellefteå, Schweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rom, Italien
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, Niederlande
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgien
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