The impact of a fellow-driven debriefing program after pediatric cardiac arrests

Gillen, Jennifer; Koncicki, Monica L.; Hough, Rebecca F.; Palumbo, Kathryn; Choudhury, Tarif; Daube, Ariel; Patel, Anita; Chirico, Amy; Lin, Cheryl; Yalamanchi, Sirisha; Aponte-Patel, Linda; Sen, Anita

doi:10.1186/s12909-019-1711-y

“…Furthermore, in a clinical setting, the potential benefits of debriefing can be delivered at a relatively low cost compared to a face-to-face SBME course and without a requirement to travel to a designated simulation centre. Further benefits of Clinical Debriefing (CD) may include improved interdisciplinary understanding, development of team reflexivity and recognition of latent patient safety threats providing opportunities for pre-emptive interventions [6][7][8][9]. As a result, CD is a current area of interest in the medical education literature [6,10].…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

Coggins

¹

,

Santos

²

,

Zaklama

³

et al. 2020

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Background Defined as a ‘guided reflective learning conversation’, ‘debriefing’ is most often undertaken in small groups following healthcare simulation training. Clinical debriefing (CD) following experiences in the working environment has the potential to enhance learning and improve performance. Methods Prior to the study, a literature review was completed resulting in a standardised approach to CD that was used for training faculty. A pilot study of CD (n = 10) was then performed to derive a list of discussion topics and optimise the faculty training. The resulting debriefing approach was based on the “S.T.O.P.” structure (Summarise the case; Things that went well; Opportunities for improvement; Points of action). A debriefing aid, with suggested scripting, was provided. A subsequent observational study assessed CD within 1-h of clinical events. ‘Significantly distressing’ or ‘violent’ events were excluded. Data was collected on participant characteristics, discussion topics, and team recommendations. Study forms were non-identifiable. Subsequent analysis was performed by two investigators using content analysis of the debriefing forms (n = 71). Discussion topics (learning points) were coded using a modified version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework. One month after completion of the study, ED management staff were surveyed for reports of “harm” as the result of CD. Results During the study period, 71 CDs were recorded with a total of 506 participants. Mean debriefing length was 10.93 min (SD 5.6). Mean attendance was 7.13 (SD 3.3) participants. CD topics discussed were divided into ‘plus’ (well-done) and ‘delta’ (need to improve) groupings. 232 plus domains were recorded of which 195 (84.1%) aligned with the PEARLS debriefing framework, suggesting simulation debriefing skills may be translatable to a clinical setting. Topics discussed outside the PEARLS framework included family issues, patient outcome and environmental factors. CD reports led to preventative interventions for equipment problems and to changes in existing protocols. There were no recorded incidents of participant harm resulting from CD. Conclusions Topics discussed in CD predominantly aligned to those commonly observed in simulation-based medical education. Collective recommendations from CD can be used as evidence for improving existing protocols and models of care.

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“…(25) Pediatric and adult resuscitations are common pre-selected clinical events which should initiate a debrie ng. (14,19,24,26) Clinical events previously recognized as distressing for staff or cited as critical incidents in the literature include death of a patient, multi-trauma, and death of young patients. (1,19,27) To cope with emotionally challenging patient cases, nurses have previously reported reliance upon peer support and physicians have voiced a preference for a more formal support structure.…”

Section: Introductionmentioning

confidence: 99%

“…(1,19,27) To cope with emotionally challenging patient cases, nurses have previously reported reliance upon peer support and physicians have voiced a preference for a more formal support structure. (22,23,26) The extent of the pandemic will increase the number of patient deaths experienced by providers in high prevalence regions, further challenging provider well-being. A study of COVID-19 frontline providers found that levels of anxiety and stress were inversely related to levels of social support.…”

Section: Introductionmentioning

confidence: 99%

Baseline Well-being, Perceptions of Critical Incidents, and Openness to Debriefing in Community Hospital Emergency Department Clinical Staff Before COVID-19, A Cross-Sectional Study

Cantu

¹

,

Thomas

²

2020

Preprint

2

0

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Background: Emergency department personnel routinely bear witness to traumatic experiences and critical incidents that can affect their own well-being. Peer support through debriefing has demonstrated positive impacts on clinicians’ well-being following critical incidents. This study explored community hospital emergency department staff’s perceptions of critical incidents, assessed openness to debriefing and measured baseline well-being. Our analysis provides a baseline of provider well-being immediately prior to the local onset of COVID-19. The potential need for additional resources to support frontline providers during the pandemic can be evaluated. Method: We conducted a cross-sectional study for 4-weeks prior to the first COVID-19 case in Connecticut using a survey offered to an interprofessional group of emergency department clinical staff. The main outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Professional Quality of Life (ProQOL) scale. Pearson’s chi-square test was used to identify significant differences in perceptions of critical incidents and debriefings between professional categories. One-way ANOVA and Tukey’s test were used to analyze significant differences in well-being between professional categories. Results: Thirty-nine clinical personnel from St. Vincent’s Emergency Department responded to the survey. Events frequently selected as critical incidents were caring for critically ill children (89.7%), mass casualty events (84.6%), and death of a patient (69.2%). Critical incidents were commonly reported (81.6%) as occurring once per week. Additionally, 76.2% of participants reported wanting to discuss a critical incident with their team. Across all respondents, 45.7% scored borderline or abnormal for anxiety, 55.9% scored moderate for burnout, and 55.8% scored moderate to high for secondary traumatic stress.Conclusions: At baseline, providers reported caring for critically ill children, mass casualty events, and death of a patient as critical incidents, which typically occurred once per week. Death of a patient occurs at increased frequency during the protracted mass casualty experience of COVID-19 and threatens provider well-being. Receptiveness to post-event debriefing is high but the method is still underutilized. With nearly half of staff scoring borderline or abnormal for anxiety, burnout, and secondary traumatic stress at baseline, peer support measures should be implemented to protect frontline providers’ well-being during and after the pandemic.

show abstract

“…(25) Pediatric and adult resuscitations are common preselected clinical events which should initiate a debrie ng. (14,19,24,26) Clinical events previously recognized as distressing for staff or cited as critical incidents in the literature include death of a patient, multi-trauma, and death of young patients. (1,19,27) To cope with emotionally challenging patient cases, nurses have previously reported reliance upon peer support and physicians have voiced a preference for a more formal support structure.…”

Section: Introductionmentioning

confidence: 99%

“…(1,19,27) To cope with emotionally challenging patient cases, nurses have previously reported reliance upon peer support and physicians have voiced a preference for a more formal support structure. (22,23,26) The aim of this study is to describe the well-being of community hospital emergency department clinical staff immediately prior to the local onset of COVID-19 and identify their perceptions surrounding critical incidents and post-event, discussion-based interventions. The current low level of hospital instituted peer support programs and current risks to health professional' well-being needs to be addressed.…”

Section: Introductionmentioning

confidence: 99%

Baseline Well-being, Perceptions of Critical Incidents, and Openness to Debriefing in Community Hospital Emergency Department Clinical Staff Before COVID-19, a Cross-Sectional Study

Cantu

¹

,

Thomas

²

2020

Preprint

0

View full text Add to dashboard Cite

Background: Emergency department personnel routinely bear witness to traumatic experiences and critical incidents that can affect their own well-being. Peer support through debriefing has demonstrated positive impacts on clinicians’ well-being following critical incidents. This study explored community hospital emergency department staff’s perceptions of critical incidents, assessed openness to debriefing and measured baseline well-being. Our analysis provides a baseline of provider well-being immediately prior to the local onset of COVID-19. The potential need for additional resources to support frontline providers during the pandemic can be evaluated. Method: We conducted a cross-sectional study for 4-weeks prior to the first COVID-19 case in Connecticut using a survey offered to an interprofessional group of emergency department clinical staff. The main outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Professional Quality of Life (ProQOL) scale. Pearson’s chi-square test was used to identify significant differences in perceptions of critical incidents and debriefings between professional categories. One-way ANOVA and Tukey’s test were used to analyze significant differences in well-being between professional categories. Results: Thirty-nine clinical personnel from St. Vincent’s Emergency Department responded to the survey. Events frequently selected as critical incidents were caring for critically ill children (89.7%), mass casualty events (84.6%), and death of a patient (69.2%). Critical incidents were commonly reported (81.6%) as occurring once per week. Additionally, 76.2% of participants reported wanting to discuss a critical incident with their team. Across all respondents, 45.7% scored borderline or abnormal for anxiety, 55.9% scored moderate for burnout, and 55.8% scored moderate to high for secondary traumatic stress.Conclusions: At baseline, providers reported caring for critically ill children, mass casualty events, and death of a patient as critical incidents, which typically occurred once per week. Death of a patient occurs at increased frequency during the protracted mass casualty experience of COVID-19 and threatens provider well-being. Receptiveness to post-event debriefing is high but the method is still underutilized. With nearly half of staff scoring borderline or abnormal for anxiety, burnout, and secondary traumatic stress at baseline, peer support measures should be implemented to protect frontline providers’ well-being during and after the pandemic.

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The impact of a fellow-driven debriefing program after pediatric cardiac arrests

Cited by 17 publications

References 23 publications

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes

Baseline Well-being, Perceptions of Critical Incidents, and Openness to Debriefing in Community Hospital Emergency Department Clinical Staff Before COVID-19, A Cross-Sectional Study

Baseline Well-being, Perceptions of Critical Incidents, and Openness to Debriefing in Community Hospital Emergency Department Clinical Staff Before COVID-19, a Cross-Sectional Study

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