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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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Teles D, Silva M, Berger-Estilita J, Pereira H. Practice of debriefing of critical events: a survey-based cross-sectional study of Portuguese anesthesiologists. Porto Biomed J 2023; 8:215. [PMID: 37362021 PMCID: PMC10289546 DOI: 10.1097/j.pbj.0000000000000215] [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: 11/22/2022] [Accepted: 04/20/2023] [Indexed: 06/28/2023] Open
Abstract
Debriefing is an essential procedure for identifying medical errors, improving communication, reviewing team performance, and providing emotional support after a critical event. This study aimed to describe the current practice and limitations of debriefing and gauge opinions on the best timing, effectiveness, need for training, use of established format, and expected goals of debriefing among Portuguese anesthesiologists. Methods We performed a national cross-sectional online survey exploring the practice of anesthesiologists' debriefing practice after critical events in Portuguese hospitals. The questionnaire was distributed using a snowball sampling technique from July to September 2021. Data were descriptively and comparatively analyzed. Results We had replies from 186 anesthesiologists (11.3% of the Portuguese pool). Acute respiratory event was the most reported type of critical event (96%). Debriefing occurred rarely or never in 53% of cases, 59% of respondents needed more training in debriefing, and only 4% reported having specific tools in their institutions to carry it out. There was no statistical association between having a debriefing protocol and the occurrence of critical events (P=.474) or having trained personnel (P=.95). The existence of protocols was associated with lower frequencies of debriefing (P=.017). Conclusions Portuguese anesthesiologists know that debriefing is an essential process that increases patient safety, but among those surveyed, there is a need for an adequate debriefing culture or practice. Trial registration Research registry 7741 (https://www.researchregistry.com/browse-the-registry#home).
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Affiliation(s)
- Daniel Teles
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
| | - Mariana Silva
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
| | - Joana Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland
- CINTESIS—Centre for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
| | - Helder Pereira
- Department of Anaesthesiology, University Hospital Centre of São João, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Galligan MM, Goldstein L, Garcia SM, Kellom K, Wolfe HA, Haggerty M, DeBrocco D, Barg FK, Friedlaender E. A Qualitative Study of Resident Experiences With Clinical Event Debriefing. Hosp Pediatr 2022; 12:977-989. [PMID: 36222096 DOI: 10.1542/hpeds.2022-006606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The facilitated discussion of events through clinical event debriefing (CED) can promote learning and wellbeing, but resident involvement is often limited. Although the graduate medical education field supports CED, interventions to promote resident involvement are limited by poor insight into how residents experience CED. The objective of this study was to characterize pediatric resident experiences with CED, with a specific focus on practice barriers and facilitators. METHODS We conducted this qualitative study between November and December 2020 at a large, free-standing children's hospital. We recruited pediatric residents from postgraduate years 1 to 4 to participate in virtual focus groups. Focus groups were digitally recorded, deidentified, and transcribed. Transcripts were entered into coding software for analysis. We analyzed the data using a modified grounded theory approach to identify major themes. RESULTS We conducted 4 mixed-level focus groups with 26 residents. Our analysis identified multiple barriers and facilitators of resident involvement in CED. Several barriers were logistical in nature, but the most salient barriers were derived from unique features of the resident role. For example, residents described the transience of their role as a barrier to both participating and engaging in CED. However, they described advancing professional experience and the desire for reflective learning as facilitators. CONCLUSIONS Residents in this study highlighted many factors affecting their participation and engagement in CED, including barriers related to the unique features of their role. On the basis of resident experiences, we propose several recommendations for CED practice that graduate medical education programs and hospitals should consider for supporting resident involvement in CED.
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Affiliation(s)
- Meghan M Galligan
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness
| | | | | | | | | | | | - Dawn DeBrocco
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Frances K Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Clinical Debriefing in Cardiology Teams: A National Survey in Spain. J Nurs Care Qual 2022; 37:E67-E72. [PMID: 35984691 DOI: 10.1097/ncq.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical debriefing (CD) improves patient safety and builds team resilience. PURPOSE We describe the current use of CD by multiprofessional Spanish cardiology team members. METHODS A self-administered survey exploring 31 items was disseminated online in October 2020. A comparison was made between respondents that who experience in CD with inexperienced respondents. Inferential analysis was done using Pearson's χ2 test. RESULTS Out of 167 valid responses, 45.5% had been completed by cardiology nurses. One-third of the respondents had experience in CD. Most common situations preceding CD were those with negative outcomes (81.8%). Time constraint was the most commonly reported barrier (76.3%); however, it was significantly less than the expectation of inexperienced respondents (92%, P < .01). Overall, only 28.2% reported self-confidence in their skills to lead a CD. CONCLUSIONS There is a necessity in Spanish cardiology teams to receive training in CD and embed it in their daily practice.
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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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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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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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Coggins A, Zaklama R, Szabo RA, Diaz-Navarro C, Scalese RJ, Krogh K, Eppich W. Twelve tips for facilitating and implementing clinical debriefing programmes. MEDICAL TEACHER 2021; 43:509-517. [PMID: 33032476 DOI: 10.1080/0142159x.2020.1817349] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.
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Affiliation(s)
- Andrew Coggins
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ramez Zaklama
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca A Szabo
- Department of Obstetrics and Gynaecology and Department of Medical Education, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Cristina Diaz-Navarro
- Department of Perioperative Care, Cardiff and Vale University Health Board, Cardiff, UK
| | - Ross J Scalese
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristian Krogh
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Walter Eppich
- Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Przednowek T, Stacey C, Baird K, Nolan R, Kellar J, Corser WD. Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting. Spartan Med Res J 2021; 6:21376. [PMID: 33870002 PMCID: PMC8043908 DOI: 10.51894/001c.21376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Regular debriefing has been associated with improved resource utilization and measurable improvements in team performance in crisis situations. While Emergency Department (ED) staff have often stated that they would like to be provided a formal debriefing model after "code blue" and similar events, few EDs have such protocols in place. METHODS The study consisted of two data collection processes: (1) completion of a 7-item survey distributed pre-intervention, 6-months post-intervention, and 1-year post-intervention, and (2) completion of a Rapid Post-Code Debriefing form. Overall responses were measured on a possible 0-10 scale and individual responses were tracked. The debrief process was triggered by one of four criteria and followed a standard format using a readily available form. RESULTS A total of 178 pre- and post-debriefing protocol implementation survey responses were collected throughout the duration of the study. Of those, 79 (44.4%) were pre-protocol response surveys. The post-protocol responses were comprised of 51 (51.5%) six month and 48 (48.5%) 12-month surveys. The average overall satisfaction with code-response performance increased significantly following the implementation of the debriefing protocol, from M=6.661, SD=2.028 to M=7.90, SD=1.359 (independent t-test = 5.069, p<0.001). There was a statistically significant decrease regarding how respondents felt emotionally supported after a code by their staff, (Pearson Chi Square 14.977, df 4, p = 0.005). CONCLUSION During this study, implementation of a post-code debriefing resulted in increased overall satisfaction with how codes had been conducted and there was a significant change in how staff felt in regards to code team leaders and an expectation of "returning to work." However, there a noted overall decrease in perceptions of feeling supported by other staff involved during the code. Further studies in both community and academic-based ED settings are needed to further explore these complex relationships.
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Zargham S, Hanson A, Laniewicz M, Sandquist M, Kessler DO, Gilbert GE, Calhoun AW. Psychometric Testing of the Debriefing Assessment for Simulation in Healthcare (DASH) for Trainee-led, In Situ Simulations in the Pediatric Emergency Department Context. AEM EDUCATION AND TRAINING 2021; 5:e10482. [PMID: 33842804 PMCID: PMC8019148 DOI: 10.1002/aet2.10482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Effective trainee-led debriefing after critical events in the pediatric emergency department has potential to improve patient care, but debriefing assessments for this context have not been developed. This study gathers preliminary validity and reliability evidence for the Debriefing Assessment for Simulation in Healthcare (DASH) as an assessment of trainee-led post-critical event debriefing. METHODS Eight fellows led teams in three simulated critical events, each followed by a video-recorded discussion of performance mimicking impromptu debriefings occurring after real clinical events. Three raters assessed the recorded debriefings using the DASH, and their feedback was collated. Data were analyzed using generalizability theory, Gwet's AC2, intraclass correlation coefficient (ICC), and coefficient alpha. Validity was examined using Messick's framework. RESULTS The DASH instrument had relatively low traditional inter-rater reliability (Gwet's AC2 = 0.24, single-rater ICC range = 0.16-0.35), with 30% fellow, 19% rater, and 23% rater by fellow variance. DASH generalizability (G) coefficient was 0.72, confirming inadequate reliability for research purposes. Decision (D) study results suggest the DASH can attain a G coefficient of 0.8 with five or more raters. Coefficient alpha was 0.95 for the DASH. A total of 90 and 40% of items from Elements 1 and 4, respectively, were deemed "not applicable" or left blank. CONCLUSIONS Our results suggest that the DASH does not have sufficient validity and reliability to rigorously assess debriefing in the post-critical event environment but may be amenable to modification. Further development of the tool will be needed for optimal use in this context.
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Affiliation(s)
- Shiva Zargham
- From theDepartment of PediatricsUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Amy Hanson
- From theDepartment of PediatricsUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Megan Laniewicz
- From theDepartment of PediatricsUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - Mary Sandquist
- From theDepartment of PediatricsUniversity of Louisville School of MedicineLouisvilleKYUSA
| | - David O. Kessler
- and theDepartment of Emergency MedicineColumbia University Vagelos College of Physicians & SurgeonsNew YorkNYUSA
| | | | - Aaron W. Calhoun
- From theDepartment of PediatricsUniversity of Louisville School of MedicineLouisvilleKYUSA
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Chen YYK, Arriaga A. Crisis checklists in emergency medicine: another step forward for cognitive aids. BMJ Qual Saf 2021; 30:689-693. [PMID: 33766892 DOI: 10.1136/bmjqs-2021-013203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Yun-Yun K Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexander Arriaga
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA .,Center for Surgery and Public Health, Boston, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA
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Heimberg E, Daub J, Schmutz JB, Eppich W, Hoffmann F. [Debriefing in pediatric emergency care]. Notf Rett Med 2021; 24:43-51. [PMID: 33551677 PMCID: PMC7853166 DOI: 10.1007/s10049-020-00833-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
Kommunikationsfehler und systembedingte Probleme wirken sich negativ auf Teamarbeit und gemeinsame Entscheidungsfindung aus und können den Patienten Schaden zufügen. Regelmäßige Nachbesprechungen nach kritischen Ereignissen wiederum wirken sich positiv auf die Teamzusammenarbeit und das Patientenoutcome in der Kindernotfallversorgung aus. Das gemeinsame Reflektieren fördert das Lernen, hilft den Teams, sich zu verbessern, und verhindert, dass sich Fehler in Zukunft wiederholen. Dennoch werden Debriefings im präklinischen und klinischen Alltag noch immer qualitativ unzureichend durchgeführt. Gründe dafür sind mangelnde Zeit, Fehlen von erfahrenen Debriefern und fehlende Unterstützung durch Verantwortungsträger. Debriefings können je nach Bedarf zu verschiedenen Zeitpunkten mit unterschiedlicher Dauer stattfinden. Nachbesprechungen können auch rein virtuell oder als sogenannte Hybridveranstaltung durchgeführt werden. Nachbesprechungen sollten sich auf gemeinsames Lernen und das Erarbeiten zukunftsorientierter Verbesserungen konzentrieren. Nicht nur lebensbedrohliche Ereignisse können Nachbesprechungen auslösen, sondern auch potenziell kritische Situationen, wie routinemäßige Intubationen. Debriefing-Skripte fördern eine Strukturierung und ermöglichen selbst unerfahrenen Moderatoren, alle Aspekte zu bearbeiten. Neben der Diskussion schwieriger Abläufe sollten unbedingt positive Leistungen besprochen werden, um diese zu verstärken und das Lernen am Erfolg zu ermöglichen. Dabei sollten die Beweggründe eines Verhaltens erfragt und nicht nur die nach außen sichtbaren Leistungen bewertet werden. Diese Strategie fördert bedarfsgerechtes Lernen und konzentriert sich auf Lösungen. Hilfreich sind dabei spezielle Fragetechniken, echtes Interesse und eine positive Sicherheitskultur.
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Affiliation(s)
- E Heimberg
- Kinderintensivstation, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 1, 72076 Tübingen, Deutschland
| | - J Daub
- Kinderintensivstation, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 1, 72076 Tübingen, Deutschland
| | - J B Schmutz
- Department für Management, Technologie und Ökonomie, ETH Zürich, Zürich, Schweiz
| | - W Eppich
- RCSI Sim: Simulation Education and Research, Royal College of Surgeons of Ireland, Dublin, Irland
| | - F Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU München, München, Deutschland
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Toews AJ, Martin DE, Chernomas WM. Clinical debriefing: A concept analysis. J Clin Nurs 2021; 30:1491-1501. [PMID: 33434382 DOI: 10.1111/jocn.15636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition. BACKGROUND Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting. DESIGN Concept analysis. METHODS Walker and Avant's eight-step approach to concept analysis. RESULTS The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing. CONCLUSION Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings. RELEVANCE TO CLINICAL PRACTICE A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development.
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Affiliation(s)
- Andrea J Toews
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Donna E Martin
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Wanda M Chernomas
- Helen Glass Center for Nursing, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
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17
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van Dalen AS, van Haperen M, Swinkels JA, Grantcharov TP, Schijven MP. Development of a Model for Video-Assisted Postoperative Team Debriefing. J Surg Res 2021; 257:625-635. [DOI: 10.1016/j.jss.2020.07.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023]
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Servotte JC, Welch-Horan TB, Mullan P, Piazza J, Ghuysen A, Szyld D. Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19. Adv Simul (Lond) 2020; 5:32. [PMID: 33292850 PMCID: PMC7656224 DOI: 10.1186/s41077-020-00150-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic. METHODS We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10-25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed. RESULTS During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7-13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%). CONCLUSION Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.
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Affiliation(s)
- Jean-Christophe Servotte
- Public Health Sciences Department, University of Liege, Liege, Belgium
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
| | - T. Bram Welch-Horan
- Director of Simulation, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Paul Mullan
- Director of Research and Quality Improvement, Division of Emergency Medicine, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk, VA USA
| | - Justine Piazza
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
- Emergency Department, University Hospital Centre of Liege, Liege, Belgium
| | - Alexandre Ghuysen
- Public Health Sciences Department, University of Liege, Liege, Belgium
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
- Emergency Department, University Hospital Centre of Liege, Liege, Belgium
| | - Demian Szyld
- Senior Director, Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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Abstract
OBJECTIVE Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing. METHODS A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed. RESULTS There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score. CONCLUSIONS This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.
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Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
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21
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Arriaga AF, Szyld D, Pian-Smith MCM. Real-Time Debriefing After Critical Events: Exploring the Gap Between Principle and Reality. Anesthesiol Clin 2020; 38:801-820. [PMID: 33127029 PMCID: PMC7552980 DOI: 10.1016/j.anclin.2020.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alexander F Arriaga
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Ariadne Labs, Boston, MA, USA; Center for Surgery and Public Health, Boston, MA, USA.
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Medical Simulation, Boston, MA, USA. https://twitter.com/debriefmentor
| | - May C M Pian-Smith
- Center for Medical Simulation, Boston, MA, USA; Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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22
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Hale SJ, Parker MJ, Cupido C, Kam AJ. Applications of Postresuscitation Debriefing Frameworks in Emergency Settings: A Systematic Review. AEM EDUCATION AND TRAINING 2020; 4:223-230. [PMID: 32704591 PMCID: PMC7369499 DOI: 10.1002/aet2.10444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Postresuscitation debriefing (PRD) is a valuable educational tool in emergency medicine. It is recommended by international resuscitation guidelines, has been shown to improve both patient outcomes and resuscitation team performance, and is frequently requested by medical learners. However, there is limited research comparing standardized debriefing frameworks. Not only does this hinder the ability of interested emergency departments (EDs) to adopt PRD, but it limits the quality of future debriefing research. We sought to identify and compare existing PRD frameworks to inform the implementation of effective PRD in emergency medicine. METHODS We conducted a systematic review following PRISMA standards to identify debriefing frameworks used in the ED and other acute care settings for further analysis. Identified frameworks were analyzed and compared based on a method previously described in the literature. RESULTS Our search identified six frameworks, which ranged from simple tools for immediate feedback to complex, hospital-wide systems engineering-based approaches to quality improvement. Key findings were the importance of ensuring debriefing facilitators are properly selected and trained and of tailoring framework design to specific organizational targets. However, there is limited validation data for these frameworks, and more study is needed to identify and validate true best practices in PRD. CONCLUSIONS All six identified frameworks seem to be effective methods of debriefing. Given the breadth in debriefing methods and goals identified, this suggests that there may not be a one-size-fits-all approach to PRD and that organizations should instead identify their own unique needs and barriers and adopt the debriefing framework that best addresses those needs. Other findings were the importance of well-trained debriefing facilitators and the use of clear roles in organizing debriefings. Further research is needed to assess the effectiveness of postresuscitation frameworks with regard to both team performance and patient outcomes.
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Affiliation(s)
- Stephen J. Hale
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonONCanada
| | - Melissa J. Parker
- Department of PediatricsDivision of Pediatric Critical CareMcMaster UniversityHamiltonONCanada
| | - Cynthia Cupido
- Department of PediatricsDivision of Pediatric Critical CareMcMaster UniversityHamiltonONCanada
| | - April J. Kam
- Department of PediatricsDivision of Pediatric Emergency MedicineMcMaster UniversityHamiltonOntarioCanada
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23
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Abstract
BACKGROUND Postevent debriefing has been associated with improved resuscitation outcomes and is recommended by the American Heart Association and the American Academy of Pediatrics to improve clinical performance. OBJECTIVE Despite the benefits of postevent debriefing, published debriefing programs have focused on single areas within a hospital. We are unaware of any hospital-wide debriefing programs implemented in a pediatric setting. METHODS We established a multidisciplinary, interprofessional debriefing collaborative at the Children's Hospital of Philadelphia to implement postevent debriefings in multiple areas of the hospital. The collaborative created a standardized debriefing form to capture data about the postevent debriefings. RESULTS From July 23, 2015 to December 31, 2017, the emergency department performed 153 debriefings (18%) for 850 resuscitations. The neonatal intensive care unit conducted 10 debriefings (9%) for 107 resuscitations, and the pediatric intensive care unit performed 5 debriefings (7%) for 73 resuscitations. CONCLUSIONS Several departments at the Children's Hospital of Philadelphia have incorporated hot and cold debriefings into their clinical practice as part of their continuous quality improvement programs. By disseminating the tools and lessons learned from the implementation process, the collaborative hopes that other institutions will benefit from their lessons learned to successfully create their own debriefing programs. Widespread adoption of debriefing programs will enable a more scientific approach to studying the outcomes of debriefing.
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Sweeney RE, Clapp JT, Arriaga AF, Muralidharan M, Burson RC, Gordon EKB, Falk SA, Baranov DY, Fleisher LA. Understanding Debriefing: A Qualitative Study of Event Reconstruction at an Academic Medical Center. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1089-1097. [PMID: 31567173 DOI: 10.1097/acm.0000000000002999] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This qualitative study sought to characterize the role of debriefing after real critical events among anesthesia residents at the Hospital of the University of Pennsylvania. METHOD From October 2016 to June 2017 and February to April 2018, the authors conducted 25 semistructured interviews with 24 anesthesia residents after they were involved in 25 unique critical events. Interviews focused on the experience of the event and the interactions that occurred thereafter. A codebook was generated through annotation, then used by 3 researchers in an iterative process to code interview transcripts. An explanatory model was developed using an abductive approach. RESULTS In the aftermath of events, residents underwent a multistage process by which the nature of critical events and the role of residents in them were continuously reconstructed. Debriefing-if it occurred-was 1 stage in this process, which also included stages of internal dialogue, event documentation, and lessons learned. Negotiated in each stage were residents' culpability, reputation, and the appropriateness of their affective response to events. CONCLUSIONS Debriefing is one of several stages of interaction that occur after a critical event; all stages play a role in shaping how the event is interpreted and remembered. Because of its dynamic role in constituting the nature of events and residents' role in them, debriefing can be a high-stakes interaction for residents, which can contribute to their reluctance to engage in it. The function and quality of debriefing can be assessed in more insightful fashion by understanding its relation to the other stages of event reconstruction.
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Affiliation(s)
- Rachel E Sweeney
- R.E. Sweeney is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. J.T. Clapp is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. A.F. Arriaga is assistant professor of anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. M. Muralidharan is research assistant, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. R.C. Burson II is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. E.K.B. Gordon is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. S.A. Falk is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. D.Y. Baranov is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. L.A. Fleisher is chair and Robert Dunning Dripps Professor of Anesthesia, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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25
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Abstract
Introduction Medical error is currently the third major cause of death in the United States after cardiac disease and cancer. A significant number of root cause analyses performed revealed that medical errors are mostly attributed to human errors and communication gaps. Debriefing has been identified as a major tool used in identifying medical errors, improving communication, reviewing team performance, and providing emotional support following a critical event. Despite being aware of the importance of debriefing, most healthcare providers fail to make use of this tool on a regular basis, and very few studies have been conducted in regard to the practice of debriefing. This study ascertains the frequency, current practice, and limitations of debriefing following critical events in a community hospital. Design/Methods This was a cross-sectional observational study conducted among attending physicians, physician assistants, residents, and nurses who work in high acuity areas located in the study location. Data on current debriefing practices were obtained and analyzed using descriptive statistics. Results A total of 130 respondents participated in this study. Following a critical event in their department, 65 (50%) respondents reported little (<25% of the time) or no practice of debriefing and only 20 (15.4%) respondents reported frequent practice (>75% of the time). Debriefing was done more than once a week as reported by 35 (26.9%) of the respondents and was led by attending physicians 77 (59.2%). The debrief session sometimes occurred immediately following a critical event (46.9%). Although 118 (90%) of the respondents feel that there is a need to receive some training on debriefing, only 51 (39%) of the respondents have received some form of formal training on the practice of debriefing. Among the healthcare providers who had some form of debriefing in their practice, the few debrief sessions held were to discuss medical management, identify problems with systems/processes, and provide emotional support. Increased workload was identified by 92 (70.8%) respondents as the major limitations to the practice of debriefing. Most respondents support that debriefing should be done immediately after a critical event such as death of a patient (123 [94.6%]), trauma resuscitation (108 [83.1%]), cardiopulmonary arrest (122 [93.8%]), and multiple casualty/disasters (95 [73.1%]). Conclusions In order to reduce medical errors, hospitals and its management team must create an environment that will encourage all patient care workers to have a debriefing session following every critical event. This can be achieved by organizing formal training, creating a template/format for debriefing, and encouraging all hospital units to make this an integral part of their work process.
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Affiliation(s)
| | - Marsha Medows
- Pediatrics, Woodhull Medical Center, Brooklyn, USA.,Pediatrics, New York University School of Medicine, New York, USA
| | | | - Joseph Chan
- Pediatrics, Woodhull Medical Center, Brooklyn, USA
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Abstract
PURPOSE OF REVIEW This review explores four different approaches and clarifies objectives for debriefing after a clinical event in the emergency department. Psychological debriefing aims to prevent or reduce symptoms of traumatic stress and normalize recovery. Psychological first aid helps team members provide each other with pragmatic social support. Debriefing for simulation-based education promotes learning by team members. Quality improvement approaches and after action reviews focus on systems improvement. RECENT FINDINGS Qualitative studies have begun to explore interactions between clinical staff after a significant clinical event. Clearer descriptions and measurements of quality improvements and the effect of clinical event debriefing on patient outcomes are appearing. An increasing number of studies describe melded, scripted approaches to the hot debrief. SUMMARY Clinical staff have consistently indicated they value debriefing after a significant clinical event. Differing objectives from different approaches have translated into a wide variety of methods and a lack of clarity about relevant outcomes to measure. Recent descriptions of scripted approaches may clarify these objectives and pave the way for measuring relevant outcomes that demonstrate the effectiveness of and find the place for debriefing in the emergency department.
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Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event. Anesthesiology 2020; 130:1039-1048. [PMID: 30829661 DOI: 10.1097/aln.0000000000002649] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. WHAT THIS ARTICLE TELLS US THAT IS NEW Failure to debrief after critical events is common among anesthesia trainees and likely anesthesia teams. Communication breakdowns are associated with a high rate of the failure to debrief. BACKGROUND Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors' objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel. METHODS At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings. RESULTS During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers. CONCLUSIONS Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief.
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28
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Abstract
BACKGROUND Postresuscitation debriefing (PRD) is recommended by the American Heart Association guidelines but is infrequently performed. Prior studies have identified barriers for pediatric emergency medicine (PEM) fellows including lack of a standardized curriculum. OBJECTIVE Our objective was to create and assess the feasibility of a time-limited, structured PRD framework entitled REFLECT: Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasize key points, Communicate clearly, and Transform the future. METHODS Each PEM fellow (n = 9) at a single center was a team leader of a pre-intervention and post-intervention videotaped, simulated resuscitation followed by a facilitated team PRD. Our intervention was a 2-hour interactive, educational workshop on debriefing and the use of the REFLECT debriefing aid. Videos of the pre-intervention and post-intervention debriefings were blindly analyzed by video reviewers to assess for the presence of debriefing characteristics contained in the REFLECT debriefing aid. PEM fellow and team member assessments of the debriefings were completed after each pre-intervention and post-intervention simulation, and written evaluations by PEM fellows and team members were analyzed. RESULTS All 9 PEM fellows completed the study. There was an improvement in the pre-intervention and post-intervention assessment of the REFLECT debriefing characteristics as determined by fellow perception (63% to 83%, P < 0.01) and team member perception (63% to 82%, P < 0.001). All debriefings lasted less than 5 minutes. There was no statistical difference between pre-intervention and post-intervention debriefing time (P = 1.00). CONCLUSIONS REFLECT is a feasible debriefing aid designed to incorporate evidence-based characteristics into a PRD.
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Debriefing in der Kindernotfallversorgung. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-019-00831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Osta AD, King MA, Serwint JR, Bostwick SB. Implementing Emotional Debriefing in Pediatric Clinical Education. Acad Pediatr 2019; 19:278-282. [PMID: 30343057 DOI: 10.1016/j.acap.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 11/18/2022]
Abstract
Challenging situations and intense emotions are inherent to clinical practice. Failure to address these emotions has been associated with health care provider burnout. One way to combat this burnout and increase resilience is participation in emotional debriefing. Although there are many models of emotional debriefings, these are not commonly performed in clinical practice. We provide a guide for implementing emotional debriefing training utilizing the American Academy of Pediatrics Resilience Curriculum into clinical training programs, with a focus on preparing senior residents and fellows to act as debriefing facilitators. Senior residents and fellows can provide in-the-moment emotional debriefing which allows for greater health care provider participation, including medical students and other pediatric trainees. Training of senior residents and fellows may allow more frequent emotional debriefing and in turn may help to improve the resilience of pediatricians when they face challenging situations in clinical practice.
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Affiliation(s)
- Amanda D Osta
- Department of Pediatrics (AD Osta), University of Illinois at Chicago, Chicago, Ill; Department of Pediatrics (MA King), Saint Louis University School of Medicine, St. Louis, Mo; Department of Pediatrics (JR Serwint), Johns Hopkins University School of Medicine, Baltimore, Md; and Department of Pediatrics (SB Bostwick), Weill Cornell Medical College, New York, NY.
| | - Marta A King
- Department of Pediatrics (AD Osta), University of Illinois at Chicago, Chicago, Ill; Department of Pediatrics (MA King), Saint Louis University School of Medicine, St. Louis, Mo; Department of Pediatrics (JR Serwint), Johns Hopkins University School of Medicine, Baltimore, Md; and Department of Pediatrics (SB Bostwick), Weill Cornell Medical College, New York, NY
| | - Janet R Serwint
- Department of Pediatrics (AD Osta), University of Illinois at Chicago, Chicago, Ill; Department of Pediatrics (MA King), Saint Louis University School of Medicine, St. Louis, Mo; Department of Pediatrics (JR Serwint), Johns Hopkins University School of Medicine, Baltimore, Md; and Department of Pediatrics (SB Bostwick), Weill Cornell Medical College, New York, NY
| | - Susan B Bostwick
- Department of Pediatrics (AD Osta), University of Illinois at Chicago, Chicago, Ill; Department of Pediatrics (MA King), Saint Louis University School of Medicine, St. Louis, Mo; Department of Pediatrics (JR Serwint), Johns Hopkins University School of Medicine, Baltimore, Md; and Department of Pediatrics (SB Bostwick), Weill Cornell Medical College, New York, NY
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Influence of Cardiopulmonary Resuscitation Coaching and Provider Role on Perception of Cardiopulmonary Resuscitation Quality During Simulated Pediatric Cardiac Arrest. Pediatr Crit Care Med 2019; 20:e191-e198. [PMID: 30951004 DOI: 10.1097/pcc.0000000000001871] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest. DESIGN Prospective, observational study. SETTING We conducted secondary analysis of data collected from a multicenter, randomized trial of providers who participated in a simulated pediatric cardiac arrest. SUBJECTS Two-hundred pediatric acute care providers. INTERVENTIONS Participants were randomized to having a cardiopulmonary resuscitation coach versus no cardiopulmonary resuscitation coach. Cardiopulmonary resuscitation coaches provided feedback on cardiopulmonary resuscitation performance and helped to coordinate key tasks. All teams used cardiopulmonary resuscitation feedback technology. MEASUREMENTS AND MAIN RESULTS Cardiopulmonary resuscitation quality was collected by the defibrillator, and perceived cardiopulmonary resuscitation quality was collected by surveying participants after the scenario. We calculated the difference between perceived and measured quality of cardiopulmonary resuscitation and defined accurate perception as no more than 10% deviation from measured quality of cardiopulmonary resuscitation. Teams with a cardiopulmonary resuscitation coach were more likely to accurately estimate chest compressions depth in comparison to teams without a cardiopulmonary resuscitation coach (odds ratio, 2.97; 95% CI, 1.61-5.46; p < 0.001). There was no significant difference detected in accurate perception of chest compressions rate between groups (odds ratio, 1.33; 95% CI, 0.77-2.32; p = 0.32). Among teams with a cardiopulmonary resuscitation coach, the cardiopulmonary resuscitation coach had the best chest compressions depth perception (80%) compared with the rest of the team (team leader 40%, airway 55%, cardiopulmonary resuscitation provider 30%) (p = 0.003). No differences were found in perception of chest compressions rate between roles (p = 0.86). CONCLUSIONS Healthcare providers improved their perception of cardiopulmonary resuscitation depth with a cardiopulmonary resuscitation coach present. The cardiopulmonary resuscitation coach had the best perception of chest compressions depth.
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A Call to Restore Your Calling: Self-care of the Emergency Physician in the Face of Life-Changing Stress-Part 1 of 6. Pediatr Emerg Care 2019; 35:319-322. [PMID: 30870336 DOI: 10.1097/pec.0000000000001807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Few practicing emergency physicians will avoid life-changing stressors such as a medical error, personal illness, malpractice litigation, or death of a patient. Many will be unprepared for the toll they will take on their lives. Some may ultimately experience burnout, post-traumatic stress disorder, and suicidal ideation. Medical education, continuing education, and maintenance of certification programs do not teach physicians to recognize helplessness, moral distress, or maladaptive coping mechanisms in themselves. Academic physicians receive little instruction on how to teach trainees and medical students the art of thriving through life-changing stressors in their career paths. Most importantly, handling a life-changing stressor is that much more overwhelming today, as physicians struggle to meet the daily challenge of providing the best patient care in a business-modeled health care environment where profit-driven performance measures (eg, productivity tracking, patient reviews) can conflict with the quality of medical care they wish to provide.Using personal vignettes and with a focus on the emergency department setting, this 6-article series examines the impact life-changing stressors have on physicians, trainees, and medical students. The authors identify internal constraints that inhibit healthy coping and tools for individuals, training programs, and health care organizations to consider adopting, as they seek to increase physician satisfaction and retention. The reader will learn to recognize physician distress and acquire strategies for self-care and peer support. The series will highlight the concept that professional fulfillment requires ongoing attention and is a work in progress.
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Sweberg T, Sen AI, Mullan PC, Cheng A, Knight L, Del Castillo J, Ikeyama T, Seshadri R, Hazinski MF, Raymond T, Niles DE, Nadkarni V, Wolfe H. Description of hot debriefings after in-hospital cardiac arrests in an international pediatric quality improvement collaborative. Resuscitation 2018; 128:181-187. [PMID: 29768181 DOI: 10.1016/j.resuscitation.2018.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/11/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The American Heart Association recommends debriefing after attempted resuscitation from in-hospital cardiac arrest (IHCA) to improve resuscitation quality and outcomes. This is the first published study detailing the utilization, process and content of hot debriefings after pediatric IHCA. METHODS Using prospective data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q), we analyzed data from 227 arrests occurring between February 1, 2016, and August 31, 2017. Hot debriefings, defined as occurring within minutes to hours of IHCA, were evaluated using a modified Team Emergency Assessment Measure framework for qualitative content analysis of debriefing comments. RESULTS Hot debriefings were performed following 108 of 227 IHCAs (47%). The median interval to debriefing was 130 min (Interquartile range [IQR] 45, 270). Median debriefing duration was 15 min (IQR 10, 20). Physicians facilitated 95% of debriefings, with a median of 9 participants (IQR 7, 11). After multivariate analysis, accounting for hospital site, debriefing frequency was not associated with patient age, gender, race, illness category or unit type. The most frequent positive (plus) comments involved cooperation/coordination (60%), communication (47%) and clinical standards (41%). The most frequent negative (delta) comments involved equipment (46%), cooperation/coordination (45%), and clinical standards (36%). CONCLUSION Approximately half of pediatric IHCAs were followed by hot debriefings. Hot debriefings were multi-disciplinary, timely, and often addressed issues of team cooperation/coordination, communication, clinical standards, and equipment. Additional studies are warranted to identify barriers to hot debriefings and to evaluate the impact of these debriefings on patient outcomes.
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Affiliation(s)
- Todd Sweberg
- Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center/Northwell Health, 269-01 76th Ave., New Hyde Park, NY 11040, United States.
| | - Anita I Sen
- Columbia University, NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway 10N-24, New York, NY 10032, United States
| | - Paul C Mullan
- Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA 23507, United States
| | - Adam Cheng
- Pediatrics and Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3H 6A8, Canada
| | - Lynda Knight
- Revive Initiative for Resuscitation Excellence, Stanford Children's Hospital, 725 Welch Rd., Palo Alto, CA 94304, United States
| | - Jimena Del Castillo
- Pediatric Intensive Care Department, Gregorio Maranon Hospital, Doctor Castelo 47, 28009 Madrid, Spain
| | - Takanari Ikeyama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, 7-426 Morioka-machi, Obu, Aichi 474-8710, Japan
| | - Roopa Seshadri
- PolicyLab, Children's Hospital of Philadelphia, 2716 South St., 10th Floor, Philadelphia, PA 19146, United States
| | - Mary Fran Hazinski
- Vanderbilt University School of Nursing, Nashville, TN 37232, United States
| | - Tia Raymond
- Department of Pediatric Cardiac Intensive Care, Medical City Children's Hospital, 7777 Forest Lane, Suite B-246, Dallas, TX 75230, United States
| | - Dana E Niles
- The Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States
| | - Vinay Nadkarni
- The Center for Simulation, Advanced Education, and Innovation, Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, United States
| | - Heather Wolfe
- University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 6Wood 6040, Philadelphia, PA 19104, United States
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Nocera M, Merritt C. Pediatric Critical Event Debriefing in Emergency Medicine Training: An Opportunity for Educational Improvement. AEM EDUCATION AND TRAINING 2017; 1:208-214. [PMID: 30051036 PMCID: PMC6001495 DOI: 10.1002/aet2.10031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In the emergency department (ED), critical events, including death and severe illness, are not uncommon. Critical events involving children, while less frequent, may be especially distressing. Debriefing following a critical event may serve several purposes: review of team performance, education, identification of errors, emotional support, and planning for future events. Debriefing skills and habits learned during training may be carried forward throughout an emergency physician's career. This study evaluates how educators in emergency medicine (EM) view debriefing after pediatric critical events and identifies barriers to use of debriefing in postgraduate training programs. METHODS In this cross-sectional observational study, we surveyed program directors (PDs) from EM residency and pediatric emergency medicine (PEM) fellowship programs via e-mail listserv. A panel of PEM experts and survey methodologists designed the survey, which was reviewed for content validity by an independent panel of EM educators. We obtained data on current debriefing practices following pediatric critical events, PDs' perceptions of ideal debriefing practices, and barriers to implementation. Data were analyzed using descriptive statistics. RESULTS A total of 109 PDs completed the survey (45% overall response rate). All respondents feel that debriefing pediatric critical events is useful. The majority of debriefings are initiated and led by emergency physicians as informal meetings shortly following a critical event. Debriefings are most commonly held following a patient death, although PDs feel that debriefings should also occur for other specific patient scenarios (e.g., child abuse). Barriers to debriefing include timing, scheduling, location, discomfort with debriefing, participant buy-in, and leader buy-in. CONCLUSIONS Program leaders in both EM and PEM believe that debriefing after pediatric critical events is important for training. Barriers to debriefing specific to the ED setting should be explored to optimize the implementation of this practice.
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Affiliation(s)
- Mariann Nocera
- Department of Emergency MedicineSection of Pediatric Emergency MedicineThe Warren Alpert Medical SchoolBrown UniversityProvidenceRI
- Departments of Pediatrics and Emergency Medicine/Traumatology Division of Pediatric Emergency Medicine Connecticut Children's Medical CenterUniversity of Connecticut School of MedicineHartfordCT
| | - Chris Merritt
- Department of Emergency MedicineSection of Pediatric Emergency MedicineThe Warren Alpert Medical SchoolBrown UniversityProvidenceRI
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Eppich WJ, Mullan PC, Brett-Fleegler M, Cheng A. “Let's Talk About It”: Translating Lessons From Health Care Simulation to Clinical Event Debriefings and Coaching Conversations. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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