Implementation of a Multidisciplinary Debriefing Process for Pediatric Ward Deterioration Events

Abstract

OBJECTIVES: Event debriefing has established benefit, but its adoption is poorly characterized among pediatric ward providers. To improve patient safety, our hospital restructured its debriefing process for ward deterioration events culminating in ICU transfer. The aim of this study was to describe this process’ implementation. METHODS: In the restructured process, multidisciplinary ward providers are expected to debrief all ICU transfers. We conducted a multimethod analysis using facilitative guides completed by debriefing participants. Monthly debriefing completion served as an adoption metric. RESULTS: Between March 2019 and February 2020, providers across 9 wards performed debriefing for 134 of 312 PICU transfers (43%). Bedside nurses participated most frequently (117 debriefings [87%]). There was no significant difference in debriefing by unit, acuity, season, or nurse staffing. Compared with units fully staffed by rotational frontline clinicians (FLCs; eg, resident physicians), units with dedicated FLCs whose responsibilities are primarily limited to that unit (eg, oncology hospitalists) completed significantly more monthly debriefings (average [SD] 57% [30%] vs 33% [28%] of PICU transfers; P = .004). FLC participation was also higher on these units (50% of debriefings [37%] vs 24% [37%]; P = .014). Through qualitative analysis, we identified distinct debriefing themes, with teaming activities such as communication cited most often. CONCLUSIONS: Implementation of a multidisciplinary debriefing process for ward deterioration events culminating in ICU transfer was associated with differential adoption across providers and FLC staffing models but not acuity or nurse staffing. Teaming activities were a debriefing priority. Future study will assess patient safety outcomes.

Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical event debriefing program and a novel qualitative model to analyze debriefing content

“…The themes that our teams identified in their debriefings are similar to prior qualitative analyses of team debriefings [18,27,38,39]. Because of rapidly changing clinical demands during the pandemic, several variations of these themes were identified.…”

Clinical progress note: Situation awareness for clinical deterioration in hospitalized children

“…An evaluation of process implementation revealed that CED participants frequently prioritize elements of teamwork—including factors affecting their ability to recognize and respond to clinical deterioration. Based on these findings, ad hoc teams may utilize hot CED as an opportunity to collectively audit and adapt their performance, so as to improve their team functioning for the remainder of the clinical shift 13 …”

“…4,10 Similarly, guided postevent reflection through clinical event debriefing (CED) can improve individual and team performance, as well as patient outcomes following resuscitation events and, is thus recommended by the American Heart Association. 13 In 2019, the Children's Hospital of Philadelphia implemented a hospital-wide CED process for deterioration events in noncritical care areas. 13 This process asks multidisciplinary ward teams to perform "hot" CED soon after events requiring escalation of care to the ICU.…”

“…13 In 2019, the Children's Hospital of Philadelphia implemented a hospital-wide CED process for deterioration events in noncritical care areas. 13 This process asks multidisciplinary ward teams to perform "hot" CED soon after events requiring escalation of care to the ICU. An evaluation of process implementation revealed that CED participants frequently prioritize elements of teamwork-including factors affecting their ability to recognize and respond to clinical deterioration.…”

“…Based on these findings, ad hoc teams may utilize hot CED as an opportunity to collectively audit and adapt their performance, so as to improve their team functioning for the remainder of the clinical shift. 13…”