Development, Implementation, and Provider Perception of Standardized Critical Event Debriefing in a Pediatric Emergency Department

Abstract

Objective Hot debriefings are communications among team members occurring shortly after an event. They have been shown to improve team performance and communication. Best practice guidelines encourage hot debriefings, but these are often not routinely performed. We aim to describe the development and implementation of a multidisciplinary hot debriefing process in our pediatric emergency department (ED), and its impact on hot debriefing completion and provider perceptions. Methods An internal tool and protocol for hot debriefings were developed by integrating responses from a survey of those who work in the ED at our institution and previously published debriefing tools. Charge nurses and pediatric emergency medicine physicians were trained to lead hot debriefings. Surveys on the perception of hot debriefings were administered before and 6 months postimplementation. Twelve-month baseline data were established by asking physicians who cared for patients who died in the ED or within 48 hours of admission to recall debrief completion. Debriefs were then prospectively tracked for 6 months postimplementation. Results Debrief completion for patient deaths in the ED or within 48 hours of admission increased from 23% (5/22) to 75% (12/16) (P < 0.001). When assessing just those deaths within the ED, this number increased from 31% (5/16) to 85% (11/13) (P < 0.001). There were 98 responses to a baseline survey (response rate, 60.5%). Most who were surveyed felt that debriefs rarely occurred, preferred hot debriefings to cold debriefings, and felt that more hot debriefings should occur. Perceived barriers included lack of time, interest, protocol, trained facilitators, departmental support, and inability to gather the team. There were 88 responses to a postintervention survey (response rate, 56.8%), 50 of which had participated in a debrief and were included in analysis. Those surveyed felt that debriefs occurred more often and were more often valuable. Most perceived that barriers were significantly reduced. Most respondents felt that hot debriefs helped address systems issues and improved performance. Conclusions Implementation of a protocol for physician or charge nurse-led hot debriefings in our pediatric ED resulted in increased completion, perceived barrier reduction, and a uniform approach to address identified issues. Pediatric EDs should consider adoption of a hot debriefing protocol given these benefits.

Red Code Management in a Pediatric Emergency Department: A Retrospective Study

“…Regarding the setting where deaths occurred, in our study, only four patients died in ED, while PICU was the setting where death mainly occurred, partially related to underlying incurable comorbidities. Despite death being a rare event in the ED setting, its management underscores the importance of not only medical expertise but also the ability to provide compassionate and empathetic care during an incredibly distressing time, providing emotional support and comfort to the grieving family and ensuring adequate debriefing for the entire teamwork [36].…”

Red Code Management in Pediatric Emergency Department: A Retrospective Study

“…Regarding the setting where deaths occurred, in our study only 4 patients died in ED, while PICU was the setting where death mainly occurred, partially related to underlying incurable comorbidities. Despite death being a rare event in the ED setting, its management underscores the importance of not only medical expertise but also of the ability to provide compassionate and empathetic care during an incredibly distressing time, providing emotional support and comfort to the grieving family and ensuring adequate debriefing for the entire teamwork [34].…”