Abstract 252: Critical Incident Debriefing After Cardiopulmonary Resuscitation in Pediatric Cardiac ICU: Effect on Patient Safety, Performance Improvement and Survey
Background: Critical incident debriefing has been established in many industries, including healthcare. To our knowledge, there have not been any published data about debriefing in the pediatric cardiac ICU (PCICU) setting.
Objective: The goal of this initiative was to test the feasibility of debriefing and to establish a multidisciplinary team process after CPR for the purpose of improvements.
Methods: This qualitative process as part of rapid cycle improvement was initiated as a method to improve patient management, and included assimilation of pertinent information, provision of immediate team feedback, safety and system improvement. After every CPR, we involved frontline staff in an informative, non-punitive, continuous quality improvement process. Debriefings lasting 10 to 15 minutes were led by the attending physicians. Issues related to communication, response time, effectiveness of the resuscitation, and support of family members was included. Participants were encouraged to express concerns and questions related to pre-code and code events to improve patient management and enhance unit safety culture. A survey of team members assessed effectiveness of the debriefing process using REDCap web application.
Results: From 2008 to 2011, 68/71 consecutive debriefings were performed. As a result, there have been several rapid cycle improvements in patient care, including preventative and anticipatory patient management, timely notification of team members, comprehensive team training via simulation training, restructuring of supply availability, family support during acute events and hospital-wide revision of the code record. One hundred twenty-three PCICU personnel were invited to complete the survey. Sixty [49%] responses were received: 100% from patient care nurse managers, 36%bedside nurses, 50% APNs, 63%physicians and 100%respiratory therapists. The beneficial aspects of the debriefing included the examination of opportunities to improve (88%), asking questions, reviewing performance (85%), and receiving education (80%).
Conclusion: Clinical debriefing in a PCICU is feasible. It positively affected the quality of patient care, enhanced the safety culture, improved occurrence reporting, and staff felt empowered.
- © 2012 by American Heart Association, Inc.