Implementation of a nurse facilitated, structured, clinical event debriefing initiative in four neonatal intensive...

Neonatal intensive care units (NICUs) often experience high acuity clinical events and can benefit from clinical event debriefing. Post-event team debriefs can reinforce success, identify areas for improvement, and support healthcare providers' (HCP) psychological coping. However, barriers exist to debriefing regularly.

To implement and evaluate a structured clinical event debriefing program in four NICUs within a regional neonatal program.

We assembled a multi-disciplinary team of clinicians and debriefing specialists, adapted an existing tool, and identified site champions. A database, debrief triggers, and feedback processes were developed. We chose charge nurses as facilitators. Facilitators were trained in 2-h virtual sessions. Debriefs were started and tracked. A post-implementation survey was conducted after 6 months.

Eighty-one HCPs responded to the pre survey. Respondents identified time constraints and skill /availability of facilitators as barriers to clinical event debriefs. Most were comfortable with debriefs prior to implementation. Ninety-five debriefs were conducted over 6 months. Median 7 (IQR 5-8) HCPs attended. Most were led by trained nurse facilitators. Debriefs took a median 12 min (IQR 8-17), and generated recommendations for equipment, teamwork, and process issues. Barriers to implementation included availability of trained facilitators, time constraints and competing quality improvement (QI) priorities. The post-implementation survey showed positive views of structured debriefs. Participants still listed time constraints as the main barrier to debriefs, although less than prior.

Nurse-led, structured clinical event debriefing can be implemented in NICUs. Clinical event debriefs allow HCPs to participate in identifying systems issues and solutions.