Department of Pediatrics, Division of Pediatric Emergency, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
Department of Pediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
BMC Emerg Med. 2022 Sep 2;22(1):152. doi: 10.1186/s12873-022-00707-4.
Post-resuscitation debriefing (PRD) is the process of facilitated, reflective discussion, enabling team-based interpersonal feedback and identification of systems-level barriers to patient care. The importance and benefits of PRD are well recognized; however, numerous barriers exist, preventing its practical implementation. Use of a debriefing tool can aid with facilitating debriefing, creating realistic objectives, and providing feedback.
To assess utility of two PRD tools, Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) and Post-Code Pause (PCP), through user preference. Secondary aims included evaluating differences in quality, subject matter, and types of feedback between tools and implications on quality improvement and patient safety.
Prospective, crossover study over a 12-month period from February 2019 to January 2020. Two PDR tools were implemented in 8 week-long blocks in acute care settings at a tertiary care children's hospital. Debriefings were triggered for any intubation, resuscitation, serious/unanticipated patient outcome, or by request for distressing situations. Post-debriefing, team members completed survey evaluations of the PDR tool used. Descriptive statistics were used to analyze survey responses. A thematic analysis was conducted to identify themes that emerged from qualitative responses.
A total of 114 debriefings took place, representing 655 total survey responses, 327 (49.9%) using PCP and 328 (50.1%) using DISCERN. 65.2% of participants found that PCP provided emotional support while only 50% of respondents reported emotional support from DISCERN. PCP was found to more strongly support clinical education (61.2% vs 56.7%). There were no significant differences in ease of use, support of the debrief process, number of newly identified improvement opportunities, or comfort in making comments or raising questions during debriefs between tools. Thematic analysis revealed six key themes: communication, quality of care, team function & dynamics, resource allocation, preparation and response, and support.
Both tools provide teams with an opportunity to reflect on critical events. PCP provided a more organized approach to debriefing, guided the conversation to key areas, and discussed team member wellbeing. When implementing a PRD tool, environmental constraints, desired level of emotional support, and the extent to which open ended data is deemed valuable should be considered.
复苏后讨论（PRD）是一个促进、反思性讨论的过程，能够实现团队内的人际反馈，并识别患者护理方面的系统障碍。PRD 的重要性和益处已得到充分认识；然而，存在许多障碍，阻碍了其实际实施。使用讨论工具可以帮助促进讨论、制定现实目标并提供反馈。
通过用户偏好评估两种 PRD 工具（DISCERN，即紧急复苏后现场讨论澄清工具，以及 Post-Code Pause（PCP））的效用。次要目标包括评估工具之间的质量、主题和反馈类型的差异，以及对质量改进和患者安全的影响。
这是一项从 2019 年 2 月至 2020 年 1 月为期 12 个月的前瞻性、交叉研究。在一家三级儿童医院的急性护理环境中，以 8 周为一个阶段，实施两种 PRD 工具。任何插管、复苏、严重/意外的患者结局或因痛苦情况而要求进行讨论时，都会触发讨论。讨论后，团队成员完成对使用的 PRD 工具的调查评估。使用描述性统计来分析调查回应。对定性回应中出现的主题进行了主题分析。
共进行了 114 次讨论，代表了 655 次总调查回应，其中 327 次（49.9%）使用 PCP，328 次（50.1%）使用 DISCERN。65.2%的参与者发现 PCP 提供了情感支持，而只有 50%的受访者报告说 DISCERN 提供了情感支持。PCP 被发现更能支持临床教育（61.2%比 56.7%）。在易用性、支持讨论过程、新确定的改进机会数量，以及在讨论中发表意见或提出问题的舒适度方面，两种工具之间没有显著差异。主题分析揭示了六个关键主题：沟通、护理质量、团队功能和动态、资源分配、准备和响应以及支持。
两种工具都为团队提供了一个反思关键事件的机会。PCP 提供了一种更有条理的讨论方法，引导对话进入关键领域，并讨论了团队成员的幸福感。在实施 PRD 工具时，应考虑环境限制、所需的情感支持程度，以及是否认为开放式数据有价值。
