Debriefing immediately after intubation in a children's emergency department is feasible and contributes to measurable improvements in patient safety

Abstract

Objective In 2013, our intubations highlighted a safety gap – only 49% achieved first‐pass success without hypoxia or hypotension. NAP4 recommended debriefing after intubation, but limited published methods existed. Primary aim is to implement a feasible process for immediate debriefing and feedback for emergency airway management. Secondary aims are to contribute to reduced frequency of adverse intubation‐related events and implement qualitative improvements in patient safety through team reflection and feedback. Methods A component of a prospective quality improvement (QI) study over 4 years in the ED of the Royal Children's Hospital, Melbourne, Australia. Debrief and feedback after intubation was one of seven study interventions. Targeted staff training and involvement of departmental leaders occurred. A post‐intervention cohort was audited in 2016. Analysis included the Team Emergency Assessment Measure. Results Immediate post‐event debriefing occurred in 39 (85%) of 46 intubations. Debriefing was short (median duration 5 min, interquartile range [IQR] 5–10) and soon after (median time 20 min, IQR 5–60). Commonest location was the resuscitation room (92%), led by the team leader (97%). Commonest barrier preventing immediate debriefing was excessive workload. Two QI process measures were assessed during debriefing (adequate resuscitation, airway plan) and case summaries distributed for 100% of intubations. Performance outcomes included contribution to 78% first‐pass success without hypoxia or hypotension. Team reflection prompted changes to environment (signage, stickers), training (skill drills), teamwork and process (communication, clinical event debriefing). Conclusion Structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety.

Utilising in situ simulation within translational simulation programmes to evaluate and improve multidisciplinary response to anaphylaxis in the paediatric emergency department

“…Adhering to time targets is important for acceptability. Although our median total duration (12 min 33 s) and debrief (9 min) were slightly longer than scheduled, they were similar to what our department had previously experienced 25 and published benchmarks 14 …”

“…16,24 Adhering to time targets is important for acceptability. Although our median total duration (12 min 33 s) and debrief (9 min) were slightly longer than scheduled, they were similar to what our department had previously experienced 25 and published benchmarks. 14 Other contributing factors included senior staff endorsement, successful time selection with flexibility (Thursday mid-morning as the most likely to have available cubicles and staff) and creating a memorable programme name (KISS).…”

What and when to debrief: a scoping review examining interprofessional clinical debriefing

“…Most papers did not quantify when immediate CD occurred; however, those that did reported that it took place minutes to hours after a specific event (see online supplemental material for details). Immediate CD lasted anywhere from 1 min to 20 min1 11 13 15 23 35–38 40–45 and was reported to be used by teams working with adult (n=15) and paediatric (n=12) populations.…”

“…Teams were reported to engage in immediate CD predominantly after traumatic or unexpected events such as resuscitation, major trauma, patient death or falls. Papers reported that all team members were invited to attend immediate CD, including non-clinical staff 11 13 21 35 45–50. This meant composition of groups engaging in CD varied considerably although medical and nursing staff were the most frequently reported 11 13 15 17 23 35 37 42 46 51 52.…”

“…Many obstacles relating to resourcing, education and culture have been identified that prevent the implementation of debriefing into clinical practice 11–24. A lack of consistency in the conceptualisation and terminology describing CD also impact implementation.…”