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Using feedback from paediatric resuscitation team members to improve quality of care
Erin Mills1,2, Jessica Nooney1,2, Annmarie Bermundo1,2
1Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
Insights
Staff feedback after pediatric resuscitations in the emergency department (ED) identified system improvements. This approach, focusing on both successes and failures, enhances patient safety and care quality.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Quality Improvement Science
Background:
- Pediatric resuscitations in the emergency department (ED) are high-pressure events.
- Traditional reviews focus on poor outcomes, potentially missing learning opportunities.
- A Safety-II approach considers all experiences to enhance care quality.
Purpose of the Study:
- To identify themes from staff feedback following pediatric resuscitations in the ED.
- To describe system changes implemented as a result of this feedback.
Main Methods:
- A prospective quality improvement study over 31 months in a tertiary pediatric ED.
- Staff surveys collected feedback on successes and areas for improvement.
- Directed content analysis and inductive thematic analysis were used, followed by discussion in departmental meetings.
Main Results:
- 1320 feedback items from 256 staff across 89 pediatric resuscitation cases.
- Key themes identified in team, environment, and tasks/technology.
- Implemented improvements included a transport checklist, airway huddle, and standardized medication preparation.
Conclusions:
- Asynchronous staff feedback identified actionable themes across the health system.
- This feedback was successfully translated into system-focused improvements.
- The study demonstrates the value of a Safety-II approach in pediatric resuscitation quality improvement.
Objective:
Paediatric resuscitations in the ED are high-pressure events in unpredictable settings. Traditionally, only cases with poor outcomes are reviewed to prevent future failures. Adopting a Safety-II mindset allows teams to reflect on both positive and negative experiences, enhancing care quality. The present study aimed to identify themes from staff feedback after paediatric resuscitations in the ED and describe system changes as a result.
Methods:
A prospective quality improvement study was conducted over 31 months in a tertiary paediatric ED. Surveys were sent to clinical staff involved in paediatric resuscitations, requesting feedback on successes and suggestions for improvement. Responses were analysed using directed content analysis: initial coding using the London Protocol, a systems-focused review methodology, followed by inductive thematic analysis. Feedback was discussed in departmental Mortality and Morbidity and Quality and Safety Meetings, leading to systemic improvements.
Results:
Eighty-nine paediatric resuscitation cases yielded 1320 specific feedback items from 256 staff members. Feedback covered all layers of the health system, with key themes focussed on the team, the environment and tasks/technology. Improvements included a transport checklist, a start-of-shift airway huddle and standardised medication preparation methods.
Conclusions:
Asynchronous feedback from staff involved in paediatric resuscitations identified positive and constructive themes across the health system. This feedback was successfully translated into a number of systems-focused actions to improve patient safety and care.
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