Postresuscitation debriefing in the pediatric emergency department: a national needs assessment

Abstract

Objectives: The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement. Methods: A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported. Results: Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment. Conclusion: PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators. RÉ SUMÉObjectifs: L'é tude avait pour objectifs d'é valuer les pratiques actuelles concernant les ré unions-bilan aprè s ré animation (RBAR) dans les services d'urgences (SU) pé diatriques au Canada, et de cerner les domaines susceptibles d'amélioration. Mé thode: Nous avons mené une enquê te sur l'é valuation nationale des besoins afin de recueillir des renseignements sur les pratiques actuelles concernant les RBAR et les points de vue sur la tenue de ces ré unions dans les SU pé diatriques. Un questionnaire a é té envoyé à des infirmiè res et infirmiers travaillant dans des SU, à des stagiaires et à des mé decins traitants, dans 10 hô pitaux pé diatriques, de soins tertiaires, partout au Canada. Des statistiques sommaires ont é té noté es. Ré sultats: Ont fait l'objet d'analyse les donné es de 183 participants (taux de ré ponse: 48.7%). Bien que 88.8% d'entre eux considè rent que les ré unions-bilan sont un processus important, 52.5% ont indiqué que ce genre de ré union aprè s des ré animations ré elles se tenaient dans moins de 25% des cas, et 68.3% ont indiqué qu'ils n'avaient pas d'attentes à l'é gard des RBAR dans leur é tablissement. De plus, 83.7% des ré pondants estimaient que les animateurs devraient avoir des compé tences particuliè res, acquises dans le cadre de sé ances de formation structuré e, mais 63.4% des animateurs n'avaient pas de formation en matiè re de ré union-bilan. Par ailleurs, 72% des participants é taient d'avis que l...

Debriefing in the Emergency Department After Clinical Events: A Practical Guide

“…Although team authority figures (eg, physician team leader, charge nurse) most commonly lead debriefings, 5,12,28,29 their role as facilitator has the potential to inhibit or bias the discussion. Adding a co-debriefer may help mitigate this effect.…”

“…12 Ideally, specific training in postevent debriefing would also incorporate education in human factors, patient safety, and quality improvement methodologies. Although integrated courses such as this do not exist, specific training in debriefing methodology for health care workers is available (although primarily focused on simulation-based debriefing).…”

“…The majority of respondents in both surveys indicated that they debriefed after less than or equal to 25% of ED resuscitations. 12,13 The majority of health care providers recognized the importance of debriefing and desired a structured debriefing program; however, insufficient time, lack of trained facilitators, and lack of a debriefing setting were cited as barriers to implementation. 12 A practical structure for debriefing after clinical events can capitalize on the rich learning opportunities unique to this often-chaotic environment.…”

“…12,13 The majority of health care providers recognized the importance of debriefing and desired a structured debriefing program; however, insufficient time, lack of trained facilitators, and lack of a debriefing setting were cited as barriers to implementation. 12 A practical structure for debriefing after clinical events can capitalize on the rich learning opportunities unique to this often-chaotic environment. In this article, we conduct an ad hoc review of the current evidence supporting team debriefing in the ED and discuss practical approaches to implementing debriefing.…”

Reply to: Sandhu et al, ‘‘Postresuscitation Debriefing In The Pediatric Emergency Department: A National Needs Assessment’’

“…To the editor: Regarding the article ''Postresuscitation Debriefing in the Pediatric Emergency Department: A National Needs Assessment'' by Sandhu and colleagues, 1 we appreciate their attention to the postresuscitation debriefing (PRD) process, a historically underperformed and understudied area in the emergency department (ED). 2 The authors advocate for the development of a debriefing tool for PRD.…”