Abstract
Aim
Multiple guidelines recommend debriefing of resuscitations to improve clinical performance.
We implemented a novel standardized debriefing program using a Debriefing In Situ
Conversation after Emergent Resuscitation Now (DISCERN) tool.
Methods
Following the development of the evidence-based DISCERN tool, we conducted an observational
study of all resuscitations (intubation, CPR, and/or defibrillation) at a pediatric
emergency department (ED) over one year. Resuscitation interventions, patient survival,
and physician team leader characteristics were analyzed as predictors for debriefing.
Each debriefing's participants, time duration, and content were recorded. Thematic
content of debriefings was categorized by framework approach into Team Emergency Assessment
Measure (TEAM) elements.
Results
There were 241 resuscitations and 63 (26%) debriefings. A higher proportion of debriefings
occurred after CPR (p < 0.001) or ED death (p < 0.001). Debriefing participants always included an attending and nurse; the median
number of staff roles present was six. Median intervals (from resuscitation end to
start of debriefing) & debriefing durations were 33 (IQR 15, 67) and 10 min (IQR 5, 12), respectively. Common TEAM themes included co-operation/coordination
(30%), communication (22%), and situational awareness (15%). Stated reasons for not
debriefing included: unnecessary (78%), time constraints (19%), or other reasons (3%).
Conclusions
Debriefings with the DISCERN tool usually involved higher acuity resuscitations, involved
most of the indicated personnel, and lasted less than 10 min. Future studies are needed to evaluate the tool for adaptation to other settings
and potential impacts on education, quality improvement programming, and staff emotional
well-being.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Teamwork and patient safety in dynamic domains of healthcare: a review of the literature.Acta Anaesthesiol Scand. 2009; 53: 143-151
- Communication during trauma resuscitation: do we know what is happening?.Injury. 2005; 36: 905-911
- Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human – Building a Safer Health System.National Academy Press, Washington, DC2000 (Accessed at http://www.nap.edu/catalog.php?record_id=9728 on 1/4/2013)
- Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.JAMA. 2005; 293: 305-310
- Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.JAMA. 2005; 293: 299-304
- European Resuscitation Council Guidelines for Resuscitation 2010 Section 9, Principles of education in resuscitation.Resuscitation. 2010; 81: 1434-1444
- Part 16: education, implementation, and teams: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2010; 122: S920-S933
- The role of debriefing in simulation-based learning.Simul Healthc. 2007; 2: 115-125
- Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: a survey of internal medicine residents.Crit Care Med. 2007; 35: 1668-1672
- Communication between members of the cardiac arrest team – a postal survey.Resuscitation. 2001; 49: 175-177
- Debriefing after failed paediatric resuscitation: a survey of current UK practice.Emerg Med J. 2008; 25: 328-330
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Debriefing critical incidents in the paediatric emergency department: current practice and perceived needs in Australia and New Zealand.Emerg Med Australas. 2009; 21: 479-483
Committee on Quality of Health Care in America – Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001.
- Patient safety in the pediatric emergency care setting.Pediatrics. 2007; 120: 1367-1375
- Evaluation of quantitative debriefing after pediatric cardiac arrest.Resuscitation. 2012; 83: 1124-1128
- Improving in-hospital cardiac arrest process and outcomes with performance debriefing.Arch Intern Med. 2008; 168: 1063-1069
- Videotape review leads to rapid and sustained learning.Am J Surg. 2003; 185: 516-520
- Debriefing medical teams: 12 evidence-based best practices and tips.Jt Comm J Qual Patient Saf. 2008; 34: 518-527
Texas Health and Safety Code Title 2. Health Subtitle H. Public Health Provisions, Ch.161.; 2012.
Texas Statutes – Section 160.007: Confidentiality Relating to Medical Peer Review Committee, 2012.
- Operations, engineering, and management.Academic Press, Burlington, MA, USA2007
American Heart Association (AHA): Structured and Supported Debriefing Course. <http://www.heart.org/HEARTORG/CPRAndECC/InstructorNetwork/InstructorResources/Structured-and-Supported-Debriefing-Course_UCM_304285_Article.jsp>; 2012 [accessed 13.09.12].
- Qualitative research in health care.Blackwell Pub./BMJ Books, Malden, MA2006
- Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM).Resuscitation. 2010; 81: 446-452
- One method of coping: resident debriefing after the death of a patient.J Pediatr. 2004; 145: 229-234
- Specialist registrars’ emotional responses to a patient's death.Arch Dis Child. 2006; 91: 774-776
- The role of teamwork and communication in the emergency department: a systematic review.Int Emerg Nurs. 2010; 18: 127-137
- Team training: implications for emergency and critical care pediatrics.Curr Opin Pediatr. 2008; 20: 255-260
- Building a simulation-based crisis resource management course for emergency medicine, phase 1: results from an interdisciplinary needs assessment survey.Acad Emerg Med. 2008; 15: 1136-1143
- Enhancing patient safety in the pediatric emergency department: teams, communication, and lessons from crew resource management.Pediatr Emerg Care. 2010; 26 (quiz 949–51): 942-948
- Quality of CPR project collaborators, the effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.Scand J Trauma Resusc Emerg Med. 2011; 19: 58
Harris F. Immediate post-event debriefing improves multiple aspects of response to codes and increases staff satisfaction: Agency for Healthcare Research and Quality – Service Delivery Innovation Profile. <http://innovations.ahrq.gov/content.aspx?id=3053>; 2011 [accessed 13.09.12].
- Emergency nurses’ perceptions of critical incidents and stress debriefing.J Emerg Nurs. 1993; 19: 431-436
Article info
Publication history
Published online: December 26, 2012
Accepted:
December 3,
2012
Received in revised form:
October 26,
2012
Received:
September 14,
2012
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.12.005.
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
