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Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric
Jonathan A Hermel1,2,3, Yvette Wang2,3,4, Jamie M Klapp2,3
1From the Division of Neonatology, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA.
Insights
Structured debriefing completion in pediatric emergency departments increased significantly after implementing targeted interventions. This improvement in clinical debriefs occurred without negatively impacting patient flow metrics.
Area of Science:
- Emergency Medicine
- Quality Improvement
- Healthcare Management
Background:
- Multidisciplinary clinical debriefs are crucial for performance assessment and team support but are underutilized.
- Pediatric emergency departments (EDs) face challenges in completing debriefs after critical events like cardiac arrests and intubations.
Purpose of the Study:
- To increase the completion rate of structured debrief forms following critical events in a pediatric ED.
- To evaluate the impact of interventions on debrief completion and assess potential workflow disruptions.
Main Methods:
- A key driver diagram guided the implementation of a standardized electronic debrief form (REDCap) with a plus-delta framework.
- Interventions included accessible QR codes, prompt completion targets (30 minutes, 7 minutes), and educational initiatives with nursing champions.
- Statistical process control was used to monitor changes in debrief completion and patient flow times (room-to-provider, door-to-provider).
Main Results:
- Debrief completion rates rose from 4% to 52% over 15 months, demonstrating a significant increase.
- Patient flow metrics showed no adverse effects, with room-to-provider times remaining stable and door-to-provider times decreasing.
Conclusions:
- A multifaceted intervention strategy effectively enhanced the utilization of structured debriefing in a high-acuity pediatric ED setting.
- The findings indicate that structured debriefing is feasible and sustainable, supported by ongoing education and team engagement, without compromising patient care efficiency.
Introduction:
Multidisciplinary clinical debriefs are structured discussions following critical events to assess performance, identify improvement opportunities, and provide team support. Despite known benefits, debriefs are underused. We aimed to increase debrief completion following pediatric emergency department (ED) cardiac arrests and endotracheal intubations. The primary outcome was the percentage of critical events with a completed debrief form. To assess potential workflow disruptions, we assessed 2 balancing measures: room-to-provider and door-to-provider times among Emergency Severity Index level 1 and 2 patients.
Methods:
A key driver diagram guided targeted interventions. We implemented a standardized Research Electronic Data Capture (REDCap) debrief form using a plus-delta framework with scripted prompts, accessible via quick response codes throughout the ED. As part of the intervention design, debriefs were encouraged within 30 minutes of the event and were designed to last 7 minutes or less. Educational initiatives included staff meetings, email reminders, newsletters, signage, and designated nursing champions. We used statistical process control to assess changes over time.
Results:
Debrief completion increased from 4% to 52% during 15 months, showing special-cause variation. Median room-to-provider times remained unchanged. Median door-to-provider times decreased during the intervention period.
Conclusions:
Multiple interventions significantly increased the use of structured debriefing without adversely affecting patient flow. Structured debriefing is both feasible and sustainable in high-acuity ED settings, particularly when supported by ongoing education and active team engagement.
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