294 Thematic Analysis of Debrief Themes Emerging from High Fidelity Interprofessional In Situ Simulations in the Emergency Department

Abstract

Resuscitation of critically ill patients is a cornerstone of emergency medicine, where outcomes are highly dependent on the complex interplay between effective teamwork, equipment and resource management and medical expertise. However, deficiencies in this process inevitably arise that negatively impact patient care. In situ simulation training has been gaining ground as an effective tool to improve emergency medical team performance. This ongoing prospective observational study involves the delivery of monthly, in situ simulations (SIM) followed by debrief sessions in two tertiary care emergency departments. This qualitative study sought to identify naturally emerging debrief themes that arose during interprofessional debrief sessions following in-situ simulations. Monthly, in situ simulation (SIM) sessions were conducted in the emergency departments of two tertiary care, academic hospitals. Sessions were composed of 2-3 high fidelity cases including management of sepsis, acute GI bleeds, cardiac arrest, pediatric resuscitation and trauma. Participants were recruited from the interprofessional team “on shift” in the ED and included attending emergency physicians, residents, nurses, respiratory therapists and other support staff. Simulation sessions were followed by a 20-minute, open format debrief facilitated by SIM trained emergency medicine faculty, residents and a nurse educator. Debriefers utilized generally techniques such as advocacy-inquiry and open-ended questioning to facilitate a free-flowing discussion on topics raised by the interprofessional team. Observational debrief data was collected by an experienced simulation nurse-research assistant from 11 SIM sessions, involving 30 cases and 181 participants. Thematic analysis was performed on debrief data compiled by the research nurse. Debrief topics (134) were grouped into 7 broad themes: equipment/resources, situational awareness, communication, leadership, medical expertise, technical/procedural skills and SIM factors. Frequencies were calculated with communication (42.5%), situational awareness (20.9%) and leadership (11.2%) emerging as the themes most commonly cited. Inherent SIM factors (10.4%) and equipment/resources (9.7%) were also somewhat common. Interestingly, medical expertise (3%) and technical/procedural skills (2.2%) were seldom mentioned. Further sub-thematic analysis uncovered the use of closed-loop communication (7.5%) and summaries from the team leader (7.5%) as the most frequent responses. Effective use of resources (5.2%), calling for help early (5.2%) and difficulty with suspension of reality during SIM (5.2%) were the next most frequently cited. Careful thematic, and sub-thematic analysis of common themes arising during interprofessional debriefing of in-situ simulation sessions identified areas of high concern among the ED critical care team - chiefly the importance of effective non-technical and teamwork skills. These data provide important direction for targeted, departmental quality improvement efforts and have the potential to positively impact overall patient care.