Pediatric Critical Event Debriefing in Emergency Medicine Training: An Opportunity for Educational Improvement

Simulation-Based Training in Clinical Event Debriefing Improves Leadership Performance

OBJECTIVES

Clinical event debriefing (CED) improves healthcare team performance and patient outcomes. Most pediatric emergency medicine (PEM) physicians do not receive formal training in leading CED. Our objectives were to develop a CED curriculum and evaluate its effect on performance, knowledge, comfort, and clinical practice.

METHODS

This was a single group pre-post-retention study. We developed a hybrid curriculum with simulation, an interactive module, and individual feedback. We invited faculty and fellows from the PEM division of our hospital to participate. During an in-person training day, participants led standardized clinical simulation scenarios followed by simulated CED with immediate feedback on their leadership performance. They watched an interactive module between scenarios. Participants returned for a retention assessment 2-6 months later with a third simulation and debrief. Participants completed surveys measuring attitudes, experiences, and knowledge. Participants also evaluated the curriculum.The primary outcome was CED leadership performance using a novel 21-item tool that we developed, the Debrief Leadership Tool for Assessment (DELTA). A blinded, trained rater measured performance with DELTA. Secondary outcomes included changes in knowledge and comfort and changes in clinical practice.

RESULTS

Twenty-seven participants enrolled and completed all parts of the curriculum and assessments. Debrief leadership performance improved by a mean of 3.7 points on DELTA pre-training to post-training (95% confidence interval = 2.7, 4.6, P < 0.01) and by 1.4 points from pre-training to retention (95% confidence interval = 0.1, 2.8, P = 0.03). Knowledge and comfort also significantly improved from pre-training to post-training and were sustained at retention. Most (67%) participants changed their clinical practice of CED after completing the curriculum. All participants would recommend the training to other PEM physicians.

CONCLUSIONS

A hybrid simulation-based curriculum in leading CED for PEM physicians was associated with improvement in CED leadership performance, knowledge, and comfort. PEM physicians incorporated training into their clinical practice.

Perioperative practitioners' experiences of critical incident debriefing: A qualitative explorative study

BACKGROUND

A critical incident is described as any unplanned event which causes, or has the potential to cause, injury to a patient. Critical incident debriefing is a team discussion to gather facts and analyse the experience, evaluate lessons learned and provide staff with support. However, this phase is often neglected.

METHODS

This UK-based explorative qualitative study aims to explore perioperative practitioners' experiences of critical incident debriefing. Data were collected from six participants through audio-recorded, semi-structured interviews. Data were analysed using a thematic analysis framework.

RESULTS

Five themes emerged detailing the advantages of critical incident debriefing, including addressing staff's personal needs and learning lessons from incidents, and the disadvantages such as time constraints and unsupportive/uninformative debriefs leading to poor-quality debriefs.

CONCLUSIONS

Implementation of a short debrief immediately post-incident to address immediate concerns, a later in-depth debrief and additional training for facilitators were recommended to improve debrief quality.

The talk debrief experience: Intervention in prehospital personnel care during the Covid-19 pandemic

This study focused on the TALK Debrief Experience in the prehospital personnel (n = 1521) of a western Spanish healthcare region during the COVID-19 Pandemic. The study aimed to apply the TALK clinical debriefing intervention to out-of-hospital clinical staff during pandemics; identify their emotions, thoughts, coping strategies, and solution proposals; determine their demands for improving well-being and coping ability; and disseminate valuable knowledge for addressing trauma in similar situations. The study employed a qualitative methodology within a participatory action research (PAR) framework, conducting group discussions (n = 375) and employing the TALK clinical debriefing method as the guiding framework for the sessions. The discussion group meetings were facilitated by psychologists (n = 67) who had received training in this intervention technique. Various emotions were identified during the sessions, including fear of contagion, lack of control and security, work-related stress, and ethical dilemmas. Proposed solutions and coping strategies addressed increased security measures, promotion of social distancing, stress and anxiety management, and clarity in procedures and provision of protective equipment. The study also highlighted additional demands such as the need for clear information, psychological support, and changes in work practices like reducing strenuous shifts. In conclusion, despite study limitations, such as the lack of long-term follow-up, it emphasized the importance of comprehensively addressing well-being and working conditions during health crises.

What and when to debrief: a scoping review examining interprofessional clinical debriefing

INTRODUCTION

Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts.

METHODS

Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches.

RESULTS

Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD.

CONCLUSIONS

The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

Development, Implementation, and Provider Perception of Standardized Critical Event Debriefing in a Pediatric Emergency Department

OBJECTIVE

Hot debriefings are communications among team members occurring shortly after an event. They have been shown to improve team performance and communication. Best practice guidelines encourage hot debriefings, but these are often not routinely performed. We aim to describe the development and implementation of a multidisciplinary hot debriefing process in our pediatric emergency department (ED), and its impact on hot debriefing completion and provider perceptions.

METHODS

An internal tool and protocol for hot debriefings were developed by integrating responses from a survey of those who work in the ED at our institution and previously published debriefing tools. Charge nurses and pediatric emergency medicine physicians were trained to lead hot debriefings. Surveys on the perception of hot debriefings were administered before and 6 months postimplementation.Twelve-month baseline data were established by asking physicians who cared for patients who died in the ED or within 48 hours of admission to recall debrief completion. Debriefs were then prospectively tracked for 6 months postimplementation.

RESULTS

Debrief completion for patient deaths in the ED or within 48 hours of admission increased from 23% (5/22) to 75% (12/16) ( P < 0.001). When assessing just those deaths within the ED, this number increased from 31% (5/16) to 85% (11/13) ( P < 0.001).There were 98 responses to a baseline survey (response rate, 60.5%). Most who were surveyed felt that debriefs rarely occurred, preferred hot debriefings to cold debriefings, and felt that more hot debriefings should occur. Perceived barriers included lack of time, interest, protocol, trained facilitators, departmental support, and inability to gather the team.There were 88 responses to a postintervention survey (response rate, 56.8%), 50 of which had participated in a debrief and were included in analysis. Those surveyed felt that debriefs occurred more often and were more often valuable. Most perceived that barriers were significantly reduced. Most respondents felt that hot debriefs helped address systems issues and improved performance.

CONCLUSIONS

Implementation of a protocol for physician or charge nurse-led hot debriefings in our pediatric ED resulted in increased completion, perceived barrier reduction, and a uniform approach to address identified issues. Pediatric EDs should consider adoption of a hot debriefing protocol given these benefits.

Determining the Association Between Emergency Department Crowding and Debriefing After Pediatric Trauma Resuscitations

BACKGROUND

Debriefing in the pediatric emergency department (PED) is an invaluable tool to improve team well-being, communication, and performance. Despite evidence, surveys have reported heavy workload as a barrier to debriefing leading to missed opportunities for improvement in an already busy ED. The study aims to determine the association between the incidence of debriefing after pediatric trauma resuscitations and PED crowding.

METHODS

A total of 491 Trauma One activations in Riley Children's Hospital Pediatric Emergency Department that presented between April 2018 to December 2019 were included in the study. Debriefing documentations, patient demographics, time and date of presentation, mechanism of injury, injury severity score, disposition from PED, and length of stay (LOS) were collected and analyzed. The National Emergency Department Overcrowding Scale score at arrival, Average LOS, total PED census, total PED waiting room census, and rates of left without being seen were compared between groups.

RESULTS

Of 491 Trauma One activations presented to our PED, 50 (10%) trauma evaluations had documented debriefing. The National Emergency Department Overcrowding Scale score at presentation was significantly lower in those with debriefing versus without debriefing. In addition, the PED hourly census, waiting room census, average LOS, and left without being seen were also significantly lower in the group with debriefing. In addition, trauma cases with debriefing had a higher proportion of patients with profound injuries and discharges to the morgue.

CONCLUSIONS

Pediatric emergency department crowding is a significant barrier to debriefing after trauma resuscitations. However, profound injuries and traumatic pediatric deaths remain the strongest predictors in conducting debriefing regardless of PED crowding status.

Exodontia skills acquisition: Focusing on clinical teaching and training

OBJECTIVES

The aim of the research was to evaluate the traditional exodontia block course. The objectives were to explore the experiences and views of students, clinical teachers and dental practitioners of the various elements of the course curriculum.

METHODS

The study was a qualitative, participatory action research study using descriptive analysis. The study was conducted at a Dental Faculty in South Africa. A purposive sample of students, clinical teachers and dental practitioners were invited to participate. Focus group discussions were used to collect data which was analysed by an external coder.

RESULTS

The study population consisted of 15 undergraduate dentistry students, 10 clinical teachers and seven dental practitioners. Four broad themes with sub-themes emerged from the study. The main themes identified strengths and deficiencies of the traditional course and made recommendations for its improvement. The themes identified were i) Integration of knowledge and skills, ii) Block course structure, iii) Challenges associated, and iv) Recommendations for improvement. Overall, the participants were satisfied that the course met its objectives. The results pertaining to clinical skills acquisition identified that teaching the use of elevators and luxators in the course, and standardisation of terminology among all clinical teachers as areas requiring attention. Teaching and learning strategies such as community-based learning, peer learning, case reviews, feedback and visual technology were viewed by the student, as well as clinical teacher samples, as strategies most beneficial to clinical learning.

CONCLUSIONS

The review of the curriculum for exodontia skills acquisition and development, provided several benefits. Firstly, this research served as a quality assurance indicator. It further highlighted many teaching and learning strategies that would improve clinical skills development, reduce stress and anxiety, and support student learning. To a large extent, pertinent information was obtained that served to inform the subsequent redesigning of the course. The findings of the study augment the literature currently available on the best practice for exodontia skills acquisition and development and provide baseline information for the planning and redesign of related courses.

Have you ACED it? How to successfully implement performance-oriented, Acute Critical Event Debriefing

Acute Critical Event Debriefing (ACED) after cardiopulmonary arrests should be the standard of care. However, little literature exists on how to implement performance-focused ACED in healthcare. Based on a series of successful ACED implementations in a variety of our settings, we describe key learnings and propose best practices to aid clinicians and organizations in establishing a successful ACED program. Within this practical guide, we also present a novel, standardized debriefing tool (Hotwash) that has been adapted for a variety of clinical settings.

The mental health of laboratory and rehabilitation specialists during COVID-19: A rapid review

Backgrounds

Healthcare workers have experienced considerable stress and burnout during the COVID-19 pandemic. Among these healthcare workers are medical laboratory professionals and rehabilitation specialists, specifically, occupational therapists, and physical therapists, who all perform critical services for the functioning of a healthcare system.

Purpose

This rapid review examined the impact of the pandemic on the mental health of medical laboratory professionals (MLPs), occupational therapists (OTs) and physical therapists (PTs) and identified gaps in the research necessary to understand the impact of the pandemic on these healthcare workers.

Methods

We systematically searched "mental health" among MLPs, OTs and PTs using three databases (PsycINFO, MEDLINE, and CINAHL).

Results

Our search yielded 8887 articles, 16 of which met our criteria. Our results revealed poor mental health among all occupational groups, including burnout, depression, and anxiety. Notably, MLPs reported feeling forgotten and unappreciated compared to other healthcare groups. In general, there is a dearth of literature on the mental health of these occupational groups before and during the pandemic; therefore, unique stressors are not yet uncovered.

Conclusions

Our results highlight poor mental health outcomes for these occupational groups despite the dearth of research. In addition to more research among these groups, we recommend that policymakers focus on improving workplace cultures and embed more intrinsic incentives to improve job retention and reduce staff shortage. In future emergencies, providing timely and accurate health information to healthcare workers is imperative, which could also help reduce poor mental health outcomes.

Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical event debriefing program and a novel qualitative model to analyze debriefing content

Background

Healthcare workers faced unique challenges during the early months of the COVID-19 pandemic which necessitated rapid adaptation. Clinical event debriefings (CEDs) are one tool that teams can use to reflect after events and identify opportunities for improving their performance and their processes. There are few reports of how teams have used CEDs in the COVID-19 pandemic. Our aim is to explore the issues discussed during COVID-19 CEDs and propose a framework model for qualitatively analyzing CEDs.

Methods

This was a descriptive, qualitative study of a hospital-wide CED program at a quaternary children’s hospital between March and July 2020. CEDs were in-person, team-led, voluntary, scripted sessions using the Debriefing in Suspected COVID-19 to Encourage Reflection and Team Learning (DISCOVER-TooL). Debriefing content was qualitatively analyzed using constant comparative coding with an integrated deductive and inductive approach. A novel conceptual framework was proposed for understanding how debriefing content can be employed at various levels in a health system for learning and improvement.

Results

Thirty-one debriefings were performed and analyzed. Debriefings had a median of 7 debriefing participants, lasted a median of 10 min, and were associated with multiple systems-based process improvements. Fourteen themes and 25 subthemes were identified and categorized into a novel Input-Mediator-Output-Input Debriefing (IMOID) model. The most common themes included communication, coordination, situational awareness, team member roles, and clinical standards.

Conclusions

Teams identified diverse issues in their debriefing discussions related to areas of high performance and opportunities for improvement in their care of COVID-19 patients. This model may help healthcare systems to understand how CED tools can be used to accelerate organizational learning to promote safety and improve outcomes in changing clinical environments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-022-00226-z.

Safety Audits in the Emergency Department: Applying the Threat and Error Model to the Management of Pediatric Diabetic Ketoacidosis

OBJECTIVES

This study aims to better understand factors that impact management of patients with diabetic ketoacidosis (DKA) in the pediatric emergency department (ED) by novel application of the threat-and-error model, commonly used in the aviation industry.

METHODS

This study was a retrospective chart review of all patients diagnosed with DKA and managed in our pediatric ED during a 1-year period. A "flight plan" was created for each patient's ED visit, from triage to final disposition. Each flight was analyzed with the goal of identifying threats and errors that may impact patients' clinical status or management. Particular focus was placed on physicians' adherence to hospital and provincial DKA protocols. Unintended patient states or outcomes were also noted.

RESULTS

A total of 46 patient flights were outlined and analyzed. A total of 146 threats were identified, affecting 43 (93%) patient flights. No flight was error-free. Errors in communication and lack of adherence to protocol were the most common types of errors. Unintended patient states occurred in 30 cases (65%), some of which were preceded by at least 1 error. There were no cases of cerebral edema or death.

CONCLUSIONS

It is important to identify and appropriately mitigate threats and errors that commonly occur during initial management of DKA in the ED to prevent unintended states and patient morbidity. This study demonstrates the threat-and-error model as a potentially useful tool for focusing quality improvement initiatives in the pediatric ED setting.

Emergency clinicians' knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings

BACKGROUND

Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19.

METHODS

A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020).

RESULTS

Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4-40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability.

CONCLUSIONS

Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.

Evolution of clinical event debriefs in a quaternary pediatric emergency department after implementation of a debriefing tool

BACKGROUND

Debriefing clinical events in the emergency department (ED) can enhance team performance and provide mutual support. However, ED debriefing remains infrequent and nonstandardized. A clinical tool (DISCERN-Debriefing In Situ Conversation after Emergent Resuscitation Now) was developed to facilitate ED debriefing. To date, there are no studies providing qualitative analysis of clinical event debriefs done using such a tool. Our goal was to explore common themes elicited by debriefing following implementation of DISCERN.

METHODS

This was a retrospective mixed-methods study analyzing DISCERN data from 2012 through 2017 in a pediatric ED. Quantitative data were analyzed using descriptive statistics. With constant comparison analysis, themes were categorized when applicable within the context of crisis resource management (CRM) principles, previously used as a framework for description of nontechnical skills. Member checking was performed to ensure trustworthiness.

RESULTS

We reviewed 400 DISCERN forms. Overall, 170 (41.6%) of target clinical events were debriefed during the study period. The number of clinical events debriefed per year decreased significantly over the study period, from 118 debriefed events in 2013 to 20 debriefed events in 2017 (p < 0.001). Events were more likely to be debriefed if cardiopulmonary resuscitation was needed (odds ratio [OR] = 11.8, 95% confidence interval [CI] = 4.1-33.8]) or if the patient expired (OR = 8.9, 95% CI = 2.7-29.1]). CRM principles accounted for 81% of debriefing statements, focusing on teamwork, communication, and preparation, and these themes remained consistent throughout the study period.

CONCLUSIONS

Use of the DISCERN tool declined over the study period. The DISCERN tool was utilized more commonly after the highest-acuity events. Clinical event debriefs aligned with CRM principles, with medical knowledge discussed less frequently, and the content of debriefs remained stable over time.

Understanding sickness absence in nurses and personal support workers: Insights from frontline staff and key informants in Northeastern Ontario

BACKGROUND

Nurses and personal support workers (PSWs) have high sickness absence rates in Canada. Whilst the evidence-based literature helped to identify the variables related to sickness absenteeism, understanding "why" remains unknown. This information could benefit the healthcare sector in northeastern Ontario and in locations where healthcare is one of the largest employment sectors and where nursing staff have high absence and turnover rates.

OBJECTIVE

To identify and understand the factors associated with sickness absence among nurses and PSWs through several experiences while investigating if there are northern-related reasons to explain the high rates of sickness absence.

METHODS

In this descriptive qualitative study, focus group sessions took place with registered nurses (n = 6), registered practical nurses (n = 4), PSWs (n = 8), and key informants who specialize in occupational health and nursing unions (n = 5). Focus group sessions were transcribed verbatim followed by inductive thematic analysis.

RESULTS

Four main themes emerged, which were occupational/organizational challenges, physical health, emotional toll on mental well-being, and northern-related challenges. Descriptions of why such factors lead to sickness absence were addressed with staff shortage serving as an underlying factor.

CONCLUSION

Despite the complexity of the manifestations of sickness absence, work support and timely debriefing could reduce sickness absence and by extension, staff shortage.

Promoting hot debriefing in an emergency department

INTRODUCTION

Debriefing is a process of communication that takes place between a team following a clinical case. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence as well as potential errors made. This helps to develop plans to improve subsequent performance. While the American Heart Association and the UK Resuscitation Council recommend debriefing following every cardiac arrest attended by a healthcare professional, it has not become part of everyday practice. In the emergency department (ED), this is in part attributable to time pressures and workload. Hot debriefing is a form of debriefing which should occur 'there and then' following a clinical event. The aim of this quality improvement project was to introduce hot debriefing to our ED following all cardiac arrests.

METHODS

A hot debriefing tool was designed following simulated cardiac arrest scenarios and team feedback. This tool was then introduced to the ED for use after all cardiac arrests. The team lead was asked to complete a debrief form. These completed hot debrief forms were collated monthly and compared with the department's cardiac arrest register. Any changes made to cardiac arrest management following hot debriefing were recorded. Qualitative feedback was obtained through questionnaires.

RESULTS

During the 6-month study period, 42% of all cardiac arrest cases were followed by a hot debrief. Practice changes were made to resus room equipment, practitioners' non-technical skills and the department's educational activities. 95% of participants felt the hot debriefing tool was of 'just right' duration, 100% felt the process helped with their clinical practice, and 90% felt they benefited psychologically from the process.

CONCLUSION

The introduction of a hot debriefing tool in our department has led to real-world changes to cardiac arrest care. The process benefits participants' clinical practice as well as psychological well-being.

Twelve tips for facilitating and implementing clinical debriefing programmes

Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.

Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting

CONTEXT

Regular debriefing has been associated with improved resource utilization and measurable improvements in team performance in crisis situations. While Emergency Department (ED) staff have often stated that they would like to be provided a formal debriefing model after "code blue" and similar events, few EDs have such protocols in place.

METHODS

The study consisted of two data collection processes: (1) completion of a 7-item survey distributed pre-intervention, 6-months post-intervention, and 1-year post-intervention, and (2) completion of a Rapid Post-Code Debriefing form. Overall responses were measured on a possible 0-10 scale and individual responses were tracked. The debrief process was triggered by one of four criteria and followed a standard format using a readily available form.

RESULTS

A total of 178 pre- and post-debriefing protocol implementation survey responses were collected throughout the duration of the study. Of those, 79 (44.4%) were pre-protocol response surveys. The post-protocol responses were comprised of 51 (51.5%) six month and 48 (48.5%) 12-month surveys. The average overall satisfaction with code-response performance increased significantly following the implementation of the debriefing protocol, from M=6.661, SD=2.028 to M=7.90, SD=1.359 (independent t-test = 5.069, p<0.001). There was a statistically significant decrease regarding how respondents felt emotionally supported after a code by their staff, (Pearson Chi Square 14.977, df 4, p = 0.005).

CONCLUSION

During this study, implementation of a post-code debriefing resulted in increased overall satisfaction with how codes had been conducted and there was a significant change in how staff felt in regards to code team leaders and an expectation of "returning to work." However, there a noted overall decrease in perceptions of feeling supported by other staff involved during the code. Further studies in both community and academic-based ED settings are needed to further explore these complex relationships.

A qualitative study to investigate the psychosocial effects of operational deployments on Medical Emergency Response Team personnel

The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory. Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life.

Clinical debriefing: A concept analysis

AIMS AND OBJECTIVES

The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition.

BACKGROUND

Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting.

DESIGN

Concept analysis.

METHODS

Walker and Avant's eight-step approach to concept analysis.

RESULTS

The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing.

CONCLUSION

Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings.

RELEVANCE TO CLINICAL PRACTICE

A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development.

Critical Event Debriefing in a Community Hospital

Introduction Medical error is currently the third major cause of death in the United States after cardiac disease and cancer^. A significant number of root cause analyses performed revealed that medical errors are mostly attributed to human errors and communication gaps. Debriefing has been identified as a major tool used in identifying medical errors, improving communication, reviewing team performance, and providing emotional support following a critical event. Despite being aware of the importance of debriefing, most healthcare providers fail to make use of this tool on a regular basis, and very few studies have been conducted in regard to the practice of debriefing. This study ascertains the frequency, current practice, and limitations of debriefing following critical events in a community hospital. Design/Methods This was a cross-sectional observational study conducted among attending physicians, physician assistants, residents, and nurses who work in high acuity areas located in the study location. Data on current debriefing practices were obtained and analyzed using descriptive statistics. Results A total of 130 respondents participated in this study. Following a critical event in their department, 65 (50%) respondents reported little (<25% of the time) or no practice of debriefing and only 20 (15.4%) respondents reported frequent practice (>75% of the time). Debriefing was done more than once a week as reported by 35 (26.9%) of the respondents and was led by attending physicians 77 (59.2%). The debrief session sometimes occurred immediately following a critical event (46.9%). Although 118 (90%) of the respondents feel that there is a need to receive some training on debriefing, only 51 (39%) of the respondents have received some form of formal training on the practice of debriefing. Among the healthcare providers who had some form of debriefing in their practice, the few debrief sessions held were to discuss medical management, identify problems with systems/processes, and provide emotional support. Increased workload was identified by 92 (70.8%) respondents as the major limitations to the practice of debriefing. Most respondents support that debriefing should be done immediately after a critical event such as death of a patient (123 [94.6%]), trauma resuscitation (108 [83.1%]), cardiopulmonary arrest (122 [93.8%]), and multiple casualty/disasters (95 [73.1%]). Conclusions In order to reduce medical errors, hospitals and its management team must create an environment that will encourage all patient care workers to have a debriefing session following every critical event. This can be achieved by organizing formal training, creating a template/format for debriefing, and encouraging all hospital units to make this an integral part of their work process.

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Background:

Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs.

Objectives:

Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey.

Methods:

The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored.

Results:

In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous.

Conclusion:

The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.