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Howard R. Implementing debriefing after cardiac arrest: benefits and challenges. Nurs Stand 2024:e12273. [PMID: 38946428 DOI: 10.7748/ns.2024.e12273] [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: 03/18/2024] [Indexed: 07/02/2024]
Abstract
Healthcare professionals, including nurses, will be involved in the care and management of patients in cardiac arrest. This highly stressful and demanding situation can lead to breakdowns in communication, difficulty in decision-making and emotional distress for members of the healthcare team. Debriefing is a recommended tool that team members can use to acknowledge what went well, what could be improved and areas for learning or development. However, debriefing is often not prioritised due to pressures in clinical practice. This article discusses the benefits of debriefing and outlines some of the approaches and tools that may be used. The author argues that by recognising the importance of debriefing after cardiac arrests in the hospital setting and committing to best practices, nurses can be better prepared for the challenges of resuscitation and improve patient outcomes.
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Affiliation(s)
- Rachel Howard
- Liverpool John Moores University, Liverpool, England
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2
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Shepherd WB, Patterson K, Blake J, Ward D, Clarke A, Diaz-Navarro C, Abdulsatar F. Impact of a debrief tool in acute child and adolescent mental health inpatient units: a centre's experience. BMJ Open Qual 2024; 13:e002704. [PMID: 38782486 PMCID: PMC11116849 DOI: 10.1136/bmjoq-2023-002704] [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: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
This manuscript presents the pioneering use of a post-event staff debriefing tool, TALK, in Acute Child and Adolescent Mental Health Units (CAMHU). While unsuccessful in reducing the rate and severity of patient behavioural events, our centre observed promising psychological benefits for CAMHU staff as a result of debriefing, with the tool promoting emotional resiliency and providing a platform for open conversations. Debriefing also served as a venue for patient concerns with care to be raised by staff, addressed and reflected in updated care plans. This initiative demonstrates the utility of debriefing to foster a culture of learning, improve staff wellness and enhance patient safety in CAMHU settings.
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Affiliation(s)
- William Billal Shepherd
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Jessica Blake
- Department of Child and Adolescent Psychiatry, London Health Sciences Centre, London, Ontario, Canada
| | - Danielle Ward
- London Health Sciences Centre, London, Ontario, Canada
| | - Ashlee Clarke
- Department of Child and Adolescent Psychiatry, London Health Sciences Centre, London, Ontario, Canada
| | | | - Farah Abdulsatar
- Department of Paediatrics, Western University, London, Ontario, Canada
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Hess A, Flicek T, Watral AT, Phillips M, Derby K, Ayres S, Carney J, Voll A, Blocker R. BONE Break: A Hot Debrief Tool to Reduce Second Victim Syndrome for Nurses. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00165-X. [PMID: 38849250 DOI: 10.1016/j.jcjq.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
The pandemic has intensified clinicians' workloads, leading to an increased incidence of adverse events and subsequent second victim syndrome, with almost half of health care clinicians experiencing its symptoms. However, following a literature review, no tools were found that addressed second victim syndrome in nurses. To address these issues and the gap in the literature, the authors developed the BONE Break hot debriefing tool. BONE Break is designed to be facilitated by charge nurses or other unit leaders as a means of offering peer support to other nurses who went through an adverse event. During its initial implementation, BONE Break was employed in 43 of 46 events adverse events (93.5%), and 41 of 43 sessions (95.3%) were deemed helpful. The research team has continued to gain stakeholder buy-in and implement BONE Break across multiple sites. Future work will determine BONE Break's efficacy in enhancing long-term nursing retention and reducing second victim symptoms.
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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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Schenarts PJ, Scarborough AJ, Abraham RJ, Philip G. Teaching Before, During, and After a Surgical Resuscitation. Surg Clin North Am 2024; 104:451-471. [PMID: 38453313 DOI: 10.1016/j.suc.2023.10.004] [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] [Indexed: 03/09/2024]
Abstract
Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA.
| | - Alec J Scarborough
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - Ren J Abraham
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
| | - George Philip
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, USA
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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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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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Lorenzini G, Zamboni A, Gelati L, Di Martino A, Pellacani A, Barbieri N, Baraldi M. Emergency team competencies: scoping review for the development of a tool to support the briefing and debriefing activities of emergency healthcare providers. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2023; 3:24. [PMID: 37507807 PMCID: PMC10386683 DOI: 10.1186/s44158-023-00109-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
Globally, at least one adverse event occurs in 10% of patients using emergency, inpatient, outpatient, surgical and primary care services. Particularly in emergency health care, this problem is exacerbated by additional variables such as patient criticality, high-risk diagnostic and therapeutic interventions and varying levels of healthcare provider training. In relation to the last point, briefing and debriefing activities during an emergency reinforce staff training and support them in managing work resources, planning interventions and improving future performance. The aim of the scoping review is to explore the state of the art in human factors applied to emergency situations and to develop a new tool to support healthcare professionals in conducting evidence-based briefings and debriefings. This review was developed using a search strategy based on the Arksey and O'Malley's six-step framework for scoping reviews. The literature analysed and the data identified, which are heterogeneous due to different study methodologies, objectives and types of interventions, suggest that human factors applied to emergency situations are still under-researched. At the end of the data extraction, analysis process, authors' reviews, discussion rounds and comparison with the multidisciplinary team of healthcare providers, 42 behaviours, 33 elements and 8 domains were considered relevant and included in the Emergency Team Comptencies (ETC) briefing and debriefing tool, ranked in order of priority as follows: communication, decision-making, clinical skills, situational awareness, leadership, task management, collaboration and stress and fatigue management. Further research is needed to investigate human factors applied to emergency situations and to generate new evidence to improve clinical practice and reduce the risk of error. In the near future, further studies will be conducted by the authors to test the validity of the Emergency Team Competencies tool in objectively measuring the performance of professionals and multidisciplinary teams.
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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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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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11
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A Framework for Case-Based Learning in Prehospital Medicine: The London's Air Ambulance Experience. Air Med J 2022; 41:521-525. [PMID: 36494166 DOI: 10.1016/j.amj.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
Clinical governance is the framework around which health care organizations can maintain a higher standard of safety and care. One of the central aspects of clinical governance is continuous professional education, including case-based review and case-based learning. In this article, we present the case-based education process in use at London's Air Ambulance, a mature advanced prehospital system in London, UK. The case review process begins with an on-scene hot debrief, an informal process often involving other emergency services. This is usually followed by internal team feedback and debrief and patient follow-up. All cases are then reviewed over the next 24 to 48 hours by the duty prehospital consultant (attending) in the rapid review process. After this, certain cases are volunteered or selected for discussion in the twice weekly death and disability (D&D) meeting or the monthly dispatch meeting. A small subset of cases is highlighted through this process for full formal audit and presentation at the monthly clinical governance meetings based on their educational value. Another subset of cases involving a fatality is also discussed at the monthly clinical pathology correlation meeting with the input of local forensic pathologists. Organization of the process, structure of the meetings, and educational value are described in detail.
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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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Ching HL, Lau MS, Azmy IA, Hopper AD, Keuchel M, Gyökeres T, Kuvaev R, Macken EJ, Bhandari P, Thoufeeq M, Leclercq P, Rutter MD, Veitch AM, Bisschops R, Sanders DS. Performance measures for the SACRED team-centered approach to advanced gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54:712-722. [PMID: 35636453 DOI: 10.1055/a-1832-4232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology have defined performance measures for upper and lower gastrointestinal, pancreaticobiliary, and small-bowel endoscopy. Quality indicators to guide endoscopists in the growing field of advanced endoscopy are also underway. We propose that equal attention is given to developing the entire advanced endoscopy team and not the individual endoscopist alone.We suggest that the practice of teams intending to deliver high quality advanced endoscopy is underpinned by six crucial principles concerning: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED).
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Affiliation(s)
- Hey-Long Ching
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Michelle S Lau
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Iman A Azmy
- Department of Breast Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Andrew D Hopper
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Center Hungarian Defence Forces, Budapest, Hungary
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation.,Gastroenterology Department, Faculty of Additional Professional Education, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Elisabeth J Macken
- Division of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mo Thoufeeq
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Belgium
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
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14
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Is Team Resilience More Than the Sum of Its Parts? A Quantitative Study on Emergency Healthcare Teams during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126968. [PMID: 35742218 PMCID: PMC9222929 DOI: 10.3390/ijerph19126968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/10/2022]
Abstract
Due to the COVID-19 pandemic, emergency healthcare workers have come under even more pressure than before, threatening the workers' mental health and the continuity of care delivered by their teams. This study aims to investigate what conditions increase individual and team resilience, referring to the ability to "bounce back" from stressful situations. We also assess whether team resilience is the sum of the individual resilience of team members, or whether other conditions enhance team resilience and thus continuity of care, despite limited individual resilience. We collected survey data from 129 emergency healthcare team members in the Netherlands to examine to what extent transformational leadership and team familiarity influence the level of team resilience, either directly or mediated by individual resilience, accounting for psychological characteristics and social support. The results show two distinct pathways to enhance team resilience, directly by familiarizing team members with each other and by mobilizing family support, and indirectly but with a much weaker effect, by encouraging team members' individual resilience through transformational leadership and staffing optimistic team members with high levels of self-efficacy.
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15
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Adamakos F. Debriefing a Code: Why Bother and How to Accomplish it in Under Ten Minutes. J Emerg Med 2022; 62:692-695. [PMID: 35400511 DOI: 10.1016/j.jemermed.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Frosso Adamakos
- Department of Emergency Medicine, New York Medical College, Metropolitan-Harlem Emergency Medicine Residency, New York, New York.
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Evans JC, Evans MB, Slack M, Peddle M, Lingard L. Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts. Scand J Trauma Resusc Emerg Med 2021; 29:167. [PMID: 34863278 PMCID: PMC8642998 DOI: 10.1186/s13049-021-00980-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00980-5.
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Affiliation(s)
- J Colin Evans
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - M Blair Evans
- Department of Psychology, Western University, London, ON, Canada
| | - Meagan Slack
- Middlesex-London Paramedic Service, London, ON, Canada
| | - Michael Peddle
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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17
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Flaherty M, O'Neil VE. Psychological peer support for staff: implementing the Trauma Risk Management model in a hospital setting. NURSING MANAGEMENT (HARROW, LONDON, ENGLAND : 1994) 2021; 29:26-31. [PMID: 34664436 DOI: 10.7748/nm.2021.e1977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/09/2022]
Abstract
One of the many consequences of the coronavirus disease 2019 (COVID-19) pandemic is that the psychological well-being of nurses and other healthcare staff has received greater attention. The Supporting Our Staff (SOS) service, set up in 2017 at Northampton General Hospital NHS Trust, provides psychological peer support to staff using the Trauma Risk Management (TRiM) model. TRiM is a psychological risk assessment and peer support model designed to mitigate the risks associated with exposure to traumatic events. It was initially developed and used in the UK armed forces but has started to be used in healthcare organisations. This article describes the development and expansion of the SOS service, the implementation of the TRiM model by the SOS team, and the significant part the service has played in the trust's response to the increased psychological support needs of its staff during the COVID-19 pandemic.
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Affiliation(s)
- Moya Flaherty
- Northampton General Hospital NHS Trust, Northampton, England
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18
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Makanjee CR, Bergh AM, Xu D, Sarswat D. Creating person-al space for unspoken voices during diagnostic medical imaging examinations: a qualitative study. BMC Health Serv Res 2021; 21:954. [PMID: 34511105 PMCID: PMC8436476 DOI: 10.1186/s12913-021-06958-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space. Methods We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter. Results The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter. Conclusion To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.
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Affiliation(s)
- Chandra Rekha Makanjee
- Department of Medical Radiation Science, University of Canberra, University Drive, Bruce, ACT, 2617, Australia.
| | - Anne-Marie Bergh
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Private Bag X323, Gezina, 0083, South Africa
| | - Deon Xu
- Department of Medical Radiation Science, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
| | - Drishti Sarswat
- Department of Medical Radiation Science, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
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Li C, Sotomayor-Castillo C, Nahidi S, Kuznetsov S, Considine J, Curtis K, Fry M, Morgan D, Walker T, Burgess A, Carver H, Doyle B, Tran V, Varshney K, Shaban RZ. Emergency clinicians' knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings. Australas Emerg Care 2021; 24:186-196. [PMID: 34120888 PMCID: PMC7998048 DOI: 10.1016/j.auec.2021.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. METHODS A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). RESULTS Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4-40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability. CONCLUSIONS Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.
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Affiliation(s)
- Cecilia Li
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Cristina Sotomayor-Castillo
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Shizar Nahidi
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Sergey Kuznetsov
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Julie Considine
- Deakin University, Geelong, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, VIC, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, NSW, Australia; George Institute for Global Health, NSW, Australia; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, NSW, Australia; Northern Sydney Local Health District, Royal North Shore Hospital, Kolling Building, St Leonards, NSW, Australia
| | | | - Tony Walker
- Ambulance Victoria, Doncaster, VIC, Australia; College of Health and Biomedicine, Victoria University, VIC, Australia
| | | | | | - Brian Doyle
- Emergency Department, Royal Hobart Hospital, TAS, Australia
| | - Viet Tran
- Emergency Department, Royal Hobart Hospital, TAS, Australia; Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Kavita Varshney
- Emergency Department, Westmead Hospital, NSW, Australia; Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Ramon Z Shaban
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; New South Wales Biocontainment Centre and Department of Infectious Diseases and Sexual Health, Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia.
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20
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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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21
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Abstract
COVID-19 is a complex disease which has challenged the way in which care is provided. Cardiopulmonary resuscitation (CPR) is recognized as a potential aerosol-generating procedure, in consequence, a modified advanced life support approach needs to be followed. This article describes the actions for an adult in cardiac arrest with suspected of confirmed COVID-19 disease in a hospital setting.
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