Abstract
Background: Cold debriefing(CD) is defined as occurring after at least 1 day to several weeks after a cardiac arrest event. CD has been reported to improve patient survival when implemented in a single institution, however little is known about the nature of cold debriefings across multiple pediatric centers. Methods: Retrospective review of prospectively collected data from the Pediatric Resuscitation Quality Collaborative (pediResQ). The collaborative is comprised of 18 institutions in the US and Canada, reporting 283 cardiac arrest events at the time of analysis. We analyzed CD data from in-hospital cardiac arrest (IHCA) events between Feb 2016 and April 2018. Debriefing content was collected with a Plus/Delta framework and qualitative analysis of debriefing comments was performed utilizing a modified Team Emergency Assessment Measurement (TEAM) Framework. The TEAM framework consists of ten categories: leadership, communication, cooperation, team climate, adaptability, situational awareness (SA), prioritization, clinical standards(CS) (e.g. CPR quality), and other. Univariate and regression models were applied accounting for clustering by site. Results: CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 25.5 days [IQR 11, 41] with a duration of 60 minutes [20,60]. Median number of facilitators per event was 1 (IQR 1, 1; range 0, 3). Facilitation and/or co-facilitation was performed by physicians 94%(87/93), nurses 18%(17/93) nurse practitioners 9%(8/93) and other 8%(7/93). Attendance was varied across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], RT 0 [0, 1], administrators 1 [0, 1]. Plus comments were most commonly CS 35%(44/127) of comments, cooperation 21%(27/127) and communication 13%(16/127); Delta comments were CS 31%(41/134), cooperation 18%(24/134) communication 10%(13/134) and SA 9%(12/134). There was no difference in age, sex, race, illness category or survival outcome between events that were debriefed vs. not. Conclusions: In a multicenter pediatric IHCA collaborative, cold debriefings were performed after 33% of cardiac arrests. The majority of plus and delta comments could be categorized as clinical standards, followed by cooperation and communication.
Published Version
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