Implementation of a Multidisciplinary Debriefing Process for Pediatric Ward Deterioration Events

• DOI: 10.1542/hpeds.2020-002014
• Publication Date: 2021-04-30T09:22:19Z
• Authors: Meghan M. Galligan; Heather A. Wolfe; Kelly E. Papili; Ezra Porter; Kelly O’Shea; Hongyan Liu; Andrea Colfer; Kristin Neiswender; Kristin Granahan; Nancy McGowan; Anne Marie McGrath; Kathy N. Shaw; Robert M. Sutton
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Communication; Humans; Patient Safety; Child; 16. Peace & justice; Hospitals; 3. Good health

OBJECTIVES: Event debriefing has established benefit, but its adoption is poorly characterized among pediatric ward providers. To improve patient safety, our hospital restructured its debriefing process for ward deterioration events culminating in ICU transfer. The aim of this study was to describe this process’ implementation.

METHODS: In the restructured process, multidisciplinary ward providers are expected to debrief all ICU transfers. We conducted a multimethod analysis using facilitative guides completed by debriefing participants. Monthly debriefing completion served as an adoption metric.

RESULTS: Between March 2019 and February 2020, providers across 9 wards performed debriefing for 134 of 312 PICU transfers (43%). Bedside nurses participated most frequently (117 debriefings [87%]). There was no significant difference in debriefing by unit, acuity, season, or nurse staffing. Compared with units fully staffed by rotational frontline clinicians (FLCs; eg, resident physicians), units with dedicated FLCs whose responsibilities are primarily limited to that unit (eg, oncology hospitalists) completed significantly more monthly debriefings (average [SD] 57% [30%] vs 33% [28%] of PICU transfers; P = .004). FLC participation was also higher on these units (50% of debriefings [37%] vs 24% [37%]; P = .014). Through qualitative analysis, we identified distinct debriefing themes, with teaming activities such as communication cited most often.

CONCLUSIONS: Implementation of a multidisciplinary debriefing process for ward deterioration events culminating in ICU transfer was associated with differential adoption across providers and FLC staffing models but not acuity or nurse staffing. Teaming activities were a debriefing priority. Future study will assess patient safety outcomes.