029 - Strategies for Overcoming Barriers and Promoting Clinical Event Debriefing in Pediatrics: Lessons-Learned from a National Multi-Center Pilot Study

Publication Number: 29.6823

Theodora Stavroudis, Cedars-Sinai Guerin Children's and UCLA Geffen School of Medicine, Los Angeles, CA, United States; Rita Dadiz, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Len Y. Tanaka, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Debra L.. Weiner, Boston Children's Hospital/Harvard Medical School, Boston, MA, United States; Ahmed Moussa, Universite de Montreal Faculty of Medicine, Montreal, PQ, Canada; Julie Riccio, University of Rochester School of Medicine and Dentistry, Morristown, NJ, United States; Daniel Chiou, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Noorjahan Ali, University of Texas Southwestern Medical School, Dallas, TX, United States; Shiva Zargham, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Natasha Afonso, Texas Children's Hospital, Houston, TX, United States; Doug Dannaway, University of Oklahoma College of Medicine, Edmond, OK, United States; Renuka Mehta, Medical College of Georgia at Augusta University, Augusta, GA, United States; Heather Wolfe, The Children's Hospital of Philadelphia, Wynnewood, PA, United States; Michelle Olech-Smith, American Academy of Pediatrics, Itasca, IL, United States; Marjorie White, Heersink School of Medicine, UAB, Birmingham, AL, United States; Taylor L. Sawyer, University of Washington, Kenmore, WA, United States; Joseph O. Lopreiato, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Traci Wolbrink, Boston Children's hospital, Boston, MA, United States; Louis Halamek, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Clinical event debriefing (CED) is an important tool in the identification of strengths, weaknesses, and opportunities for improvement in healthcare delivery. By establishing a standardized national framework for CED in pediatrics, barriers and strategies for facilitating CED can be explored.

Objective: To identify factors that promote and impede CED in different clinical settings during a pilot study integrating a national framework on pediatric CED.

Design/Methods: A national framework on CED in pediatrics called the “Who, What, When, Where, Why and How in CED (WHiCED)” program was introduced to 50 participants at 4 sites over a 6-month period. The framework was created by the American Academy of Pediatrics (AAP) 17-member Task Force on CED. Clinical events (CEs) debriefed during the study period included neonatal resuscitations of newborns < 29 weeks’ gestation, neonatal resuscitations where positive pressure ventilation was provided, rapid response team activation, and events deemed needing to be debriefed by staff. CED quality metrics were queried and entered into a central online data repository. Descriptive statistics were used for analysis.

Results: Of the 29 CEDs conducted, 59% took place within 30 minutes of CEs; 73% lasted < 10 minutes in duration; 66% were led by physicians; and 75% of attendees participated (Table 1). Participants identified 1-2 strengths, 1-2 weaknesses, and 1-3 action plans per CED. Facilitators were rated as good-to-excellent in remaining objective, creating a safe environment, and encouraging reflective contribution. Factors assisting CED included debriefing right after the CE, experienced facilitation, and assistance in coordinating CED. Factors impeding CED included patient acuity (Figure 1). Respiratory care and nursing were the most common disciplines unable to attend CEDs. Participants reported positive change to patient care, patient care workflow, teamwork, safety culture, staff wellbeing and transparency as an effect of performing CED, and no change in reputation, staff retaliation, punitive action, medico-legal concerns, workload, or burnout.

Conclusion(s): Conducting CED in pediatrics to identify strengths, weaknesses, and opportunities for improvement is feasible in 10-minute CED sessions that follow within 30 minutes of CEs. Obstacles to this aim include patient acuity for which experienced facilitators and/or administrative support can assist with coordinating CEDs and ensuring all disciplines are able to attend. Currently, training resources that guide facilitators in implementing CEDs in pediatrics are under development.

Clinical Event Debriefing Facilitation Characteristics and Quality Measures