Abstract
BackgroundIn the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU). A fellow-led debriefing tool was developed as a tool for fellow development, as well as to enhance communication amongst a multidisciplinary team.MethodsA curriculum and debriefing tool for fellow facilitators was developed and introduced in a 41-bed cardiac and medical PICU. Pre- and post-intervention surveys were sent to multidisciplinary PICU providers to assess effectiveness of debriefings using newly-trained leaders, as well as changes in team communication.ResultsDebriefing occurred after 84% (63/75) of cardiac arrests post-intervention. Providers in various team roles participated in pre-intervention (129 respondents/236 invitations) and post-intervention (96 respondents /232 invitations) surveys. Providers reported that frequently occurring debriefings increased from 9 to 58%, pre- and post-intervention respectively (p < .0001). Providers reported frequent identification and discussion of learning points increased from 32% pre- to 63% post-intervention. In the 12 months post-intervention, 62% of providers agreed that the overall quality of communication during arrests had improved, and 61% would be more likely to request a debriefing after cardiac arrest.ConclusionThe introduction of a fellow-led debriefing tool resulted in regularly performed debriefings after arrests. Despite post-intervention debriefings being led by newly-trained facilitators, the majority of PICU staff expressed satisfaction with the quality of debriefing and improvement in communication during arrests, suggesting that fellow facilitators can be effective debrief leaders.
Highlights
In the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU)
Previous literature describes senior physicians leading debriefings [16], with more recent literature exploring other team members taking on this role [17]
We have demonstrated that given the proper support, clinicians other than attending physicians can be trained as effective debriefing leaders
Summary
In the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU). Structured, post-event debriefing has been shown to improve team performance in military and aviation training, where high-stress but infrequent events occur, similar to the hospital environment [4,5,6]. For novice facilitators, a scripted structure has been shown to improve the efficacy and standardization of debriefing after simulation [9]. The goals of this study were to 1) develop a debriefing tool and debriefing training curriculum, 2) train fellows to use the debriefing tool, 3) implement a standardized debriefing after each cardiac arrest in the PICU using fellow facilitators, 4) determine the Gillen et al BMC Medical Education (2019) 19:272 effectiveness of fellow-led debriefings and 5) assess the effect of fellow-led debriefings on communication amongst multidisciplinary team providers
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