Todd Sweberg1, Anita I Sen2, Paul C Mullan3, Adam Cheng4, Lynda Knight5, Jimena Del Castillo6, Takanari Ikeyama7, Roopa Seshadri8, Mary Fran Hazinski9, Tia Raymond10, Dana E Niles11, Vinay Nadkarni12, Heather Wolfe13. 1. Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center/Northwell Health, 269-01 76th Ave., New Hyde Park, NY 11040, United States. Electronic address: tsweberg@northwell.edu. 2. Columbia University, NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway 10N-24, New York, NY 10032, United States. 3. Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA 23507, United States. 4. Pediatrics and Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3H 6A8, Canada. 5. Revive Initiative for Resuscitation Excellence, Stanford Children's Hospital, 725 Welch Rd., Palo Alto, CA 94304, United States. 6. Pediatric Intensive Care Department, Gregorio Maranon Hospital, Doctor Castelo 47, 28009 Madrid, Spain. 7. Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, 7-426 Morioka-machi, Obu, Aichi 474-8710, Japan. 8. PolicyLab, Children's Hospital of Philadelphia, 2716 South St., 10th Floor, Philadelphia, PA 19146, United States. 9. Vanderbilt University School of Nursing, Nashville, TN 37232, United States. 10. Department of Pediatric Cardiac Intensive Care, Medical City Children's Hospital, 7777 Forest Lane, Suite B-246, Dallas, TX 75230, United States. 11. The Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States. 12. The Center for Simulation, Advanced Education, and Innovation, Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, United States. 13. University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 6Wood 6040, Philadelphia, PA 19104, United States.
Abstract
BACKGROUND: The American Heart Association recommends debriefing after attempted resuscitation from in-hospital cardiac arrest (IHCA) to improve resuscitation quality and outcomes. This is the first published study detailing the utilization, process and content of hot debriefings after pediatric IHCA. METHODS: Using prospective data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q), we analyzed data from 227 arrests occurring between February 1, 2016, and August 31, 2017. Hot debriefings, defined as occurring within minutes to hours of IHCA, were evaluated using a modified Team Emergency Assessment Measure framework for qualitative content analysis of debriefing comments. RESULTS: Hot debriefings were performed following 108 of 227 IHCAs (47%). The median interval to debriefing was 130 min (Interquartile range [IQR] 45, 270). Median debriefing duration was 15 min (IQR 10, 20). Physicians facilitated 95% of debriefings, with a median of 9 participants (IQR 7, 11). After multivariate analysis, accounting for hospital site, debriefing frequency was not associated with patient age, gender, race, illness category or unit type. The most frequent positive (plus) comments involved cooperation/coordination (60%), communication (47%) and clinical standards (41%). The most frequent negative (delta) comments involved equipment (46%), cooperation/coordination (45%), and clinical standards (36%). CONCLUSION: Approximately half of pediatric IHCAs were followed by hot debriefings. Hot debriefings were multi-disciplinary, timely, and often addressed issues of team cooperation/coordination, communication, clinical standards, and equipment. Additional studies are warranted to identify barriers to hot debriefings and to evaluate the impact of these debriefings on patient outcomes.
BACKGROUND: The American Heart Association recommends debriefing after attempted resuscitation from in-hospital cardiac arrest (IHCA) to improve resuscitation quality and outcomes. This is the first published study detailing the utilization, process and content of hot debriefings after pediatric IHCA. METHODS: Using prospective data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q), we analyzed data from 227 arrests occurring between February 1, 2016, and August 31, 2017. Hot debriefings, defined as occurring within minutes to hours of IHCA, were evaluated using a modified Team Emergency Assessment Measure framework for qualitative content analysis of debriefing comments. RESULTS: Hot debriefings were performed following 108 of 227 IHCAs (47%). The median interval to debriefing was 130 min (Interquartile range [IQR] 45, 270). Median debriefing duration was 15 min (IQR 10, 20). Physicians facilitated 95% of debriefings, with a median of 9 participants (IQR 7, 11). After multivariate analysis, accounting for hospital site, debriefing frequency was not associated with patient age, gender, race, illness category or unit type. The most frequent positive (plus) comments involved cooperation/coordination (60%), communication (47%) and clinical standards (41%). The most frequent negative (delta) comments involved equipment (46%), cooperation/coordination (45%), and clinical standards (36%). CONCLUSION: Approximately half of pediatric IHCAs were followed by hot debriefings. Hot debriefings were multi-disciplinary, timely, and often addressed issues of team cooperation/coordination, communication, clinical standards, and equipment. Additional studies are warranted to identify barriers to hot debriefings and to evaluate the impact of these debriefings on patient outcomes.
Authors: Kate E Hughes; Patrick G Hughes; Thomas Cahir; Jennifer Plitt; Vivienne Ng; Edward Bedrick; Rami A Ahmed Journal: BMJ Simul Technol Enhanc Learn Date: 2019-12-20
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