456 Timely Debriefing Facilitates Real-Time Communication and Feedback, Improves Team Performance, and Provides Data Clarity for Quality Improvement

Abstract

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) has four skills: leadership, communication, situation monitoring, and mutual support and three competency outcomes: knowledge, attitudes, and performance. To enhance burn team performance during critical times such as burn resuscitation, care of high acuity pediatric patients, unexpected deaths, sentinel events/near miss events or death of a long term patient, we elected to have debrief meetings to discuss the events and outcomes. A debrief meeting invites all members of the burn team to discuss the clinical summary, processes that went well, areas of improvement, questions or concerns of the team, and action items. It is a process that allows timely retrospective review of high risk cases with the multidisciplinary burn team. The debrief meetings are planned within 1 week of admission or event when possible. A survey was distributed to the multidisciplinary burn team to understand how the debrief affects performance. We conducted 8 debriefs January-September 2018. Median days to debrief after event was 6.5 days. By conducting a debrief soon after an event, the data for quality and process improvement are more accurate and allow for better evaluation of existing system processes. Overall there was an increased engagement of the team members. Of 29 respondents, majority (83%) was nursing. Nurses thought the debrief improved their performance more than non-nursing staff (96% vs 40%). Majority (86%) reported it helped them feel supported by the team and 97% of team members wished to continue the debrief process. All respondents felt the debrief helped teamwork. Open positive comments included collaboration of the team and identification of areas of improvement/education. Most negative comments were logistical (timing of the debrief and who attends) and concerns of personal criticism of feedback. Using a debrief format after our burn resuscitations, we are able to achieve real-time feedback for performance improvement. We also identify systems problems and areas for quality improvement. The debrief is also a method of closed loop communication to allow all members of the resuscitation team to provide and receive feedback. It fortified the TeamSTEPPS competency outcomes of shared mental model of knowledge and improved the attitudes of the burn team. The debrief model can be especially helpful for high acuity, low volume cases. Our next step is to add video conferencing to accommodate staff unable to attend in person. Timely debriefs enhance team performance and data accuracy for quality improvement allowing improvement of the system processes, individual and team.