In a large health system in the United States, investigators examined whether mortality, receipt of mechanical ventilation, and patient acuity changed over time among adult patients with COVID-19–related critical illness admitted to intensive care units.

There has been a proliferation of online suicide prevention training for mental health service providers. The present study evaluated the preliminary effectiveness of a web-mediated suicide prevention training program for an interdisciplinary set of mental health service providers. This pilot training project also advanced the literature by evaluating a suicide-related individual difference: the provider's need for affect (NFA). Participant NFA was evaluated as a moderator of training effectiveness. Predictors of intent to utilize training content were also identified. Mental health professionals (n ϭ 43; 18.0% response rate; majority psychologists) completed the training program. The intervention consisted of a 12-module self-paced didactic and case study-based training. Training demonstrated meaningfully sized gains in suicide prevention knowledge, perceived skills/abilities, accuracy in suicide risk judgments, and reduction in negative feelings toward patients. NFA moderated several training gains. In general, participants willing to engage emotional content benefited more from training than affectively avoidant counterparts. Posttraining self-rated suicide prevention skills and confidence in training predicted intent to use training content. The training program requires further testing, but may offer a comprehensive, user-friendly CE training program for mental health service providers. NFA findings suggest potential to tailor future training, or to identify individual differences that may need to be accounted for in clinical training and supervision. Predictors of intent to use training content are consistent with theories of health promotion. Limitations are discussed. Public Significance StatementMental health professionals, the majority of whom were psychologists, benefited from the self-paced online suicide prevention program. Findings are important because they support use of a highly accessible, evidence-informed approach to bolstering mental health professionals' abilities to work with persons experiencing suicidal ideation and behavior.

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Background: Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors' objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel.Methods: At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings.Results: During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers.conclusions: Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief. (ANESTHESIOLOGY 2019; 130:1039-48) EditoR'S PERSPEctiVE What We Already Know about This Topic• Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. What This Article Tells us That Is New• Failure to debrief after critical events is common among anesthesia trainees and likely anesthesia teams. Communication breakdowns are associated with a high rate of the failure to debrief. . Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology's articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.anEStHESioLoGY REFLEctionS FRoM tHE Wood LiBRaRY-MuSEuM

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