Wolfe Heather A, Wenger Jesse, Sutton Robert, Seshadri Roopa, Niles Dana E, Nadkarni Vinay, Duval-Arnould Jordan, Sen Anita I, Cheng Adam
University of Pennsylvania Perelman School of Medicine.
The Children's Hospital of Philadelphia.
Pediatr Qual Saf. 2020 Jul 8;5(4):e319. doi: 10.1097/pq9.0000000000000319. eCollection 2020 Jul-Aug.
Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple pediatric centers.
Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative. Data from 283 IHCA events reported between February 2016 and April 2018 were analyzed. We used a Plus/Delta framework to collect debriefing content and performed a qualitative analysis utilizing a modified Team Emergency Assessment Measurement Framework. Univariate and regression models were applied, accounting for clustering by site.
CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 26 days [IQR 11, 41] with a median duration of 60 minutes [20, 60]. Attendance was variable across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], respiratory therapists 0 [0, 1], and administrators 1 [0, 1]. "Plus" comments reported per event were most commonly clinical standards 47% (44/93), cooperation 29% (27/93), and communication 17% (16/93). "Delta" comments were in similar categories: clinical standards 44% (41/93), cooperation 26% (24/93), and communication 14% (13/93).
CDs were performed after 33% of cardiac arrests in this multicenter pediatric IHCA collaborative. The majority of plus and delta comments could be categorized as clinical standards, cooperation and communication.
临床事件汇报的作用是识别最佳和次优表现，以改善未来的表现。据报道，“冷”汇报（CD），即事件发生超过1天后进行的汇报，在一家机构中可提高患者生存率。我们试图描述多个儿科中心CD的频率和内容。
采用混合方法，对前瞻性收集的院内心脏骤停（IHCA）数据进行回顾性分析，并对儿科复苏质量（pediRES-Q）协作组中的18个国际机构进行补充调查。分析了2016年2月至2018年4月期间报告的283例IHCA事件的数据。我们使用“加/减”框架收集汇报内容，并利用改良的团队紧急评估测量框架进行定性分析。应用单变量和回归模型，并考虑到各地点的聚类情况。
在283例IHCA事件中，33%（93/283）进行了CD。汇报的中位时间为26天[四分位间距11，41]，中位时长为60分钟[20，60]。各地点的参与情况各不相同（专业、每次汇报的人数）：医生12名[四分位间距4，20]，护士1名[1，6]，呼吸治疗师0名[0，1]，管理人员1名[0，1]。每次事件报告的“加”评论最常见的是临床标准47%（44/93）、协作29%（27/93）和沟通17%（16/93）。“减”评论也在类似类别中：临床标准44%（41/93）、协作26%（24/93）和沟通14%（13/93）。
在这个多中心儿科IHCA协作组中，33%的心脏骤停事件后进行了CD。大多数“加”和“减”评论可归类为临床标准、协作和沟通。
