Improving Long-Term Sustainability of a Pediatric Acute Care Emergency Event Debriefing Process

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Bohman, Annie
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Purpose: Evaluate a newly implemented acute care emergency response clinical debriefing process for emergent events outside the ICU. Background: Post-emergency event clinical debriefing is a unique tool that has been shown to have an association with improvement in clinical patient care outcomes, individual emotional processing, team and individual performance, systems issues, and quality improvement. Sample/Setting: A survey debrief tool was implemented on four different acute care units totaling 180 beds, which occurred directly after the emergent event defined as a Code or for an acute decline in clinical status, defined as initiating CAT. The data analysis occurred over 14 weeks in the Fall of 2022. Methods: The electronic QR code survey was completed directly following the event, with the patient care team present. Quantitative and qualitative survey data were analyzed for patient-specific trends and systems characteristics surrounding the event. Results: The most common reason for a CAT/Code to be called included changes in worsening respiratory status (n=126, 72%). 47% of respondents agreed that the debrief survey helped identify and close individual and team performance gaps. Respondents did not perceive the debrief survey improved team morale or emotional processing. PEWS score >6 was documented in 5% (n=8) of all patients who had a CAT/Code event and in 10% (n=4) of patients who were also established as a Watcher. Conclusion: PEWS may not be an effective method to evaluate and predict changes in patient clinical status. Debriefs hours to days following the event may have greater potential to improve the emotional processing of events instead of immediately following, which may better identify and close team performance gaps surrounding the event. Watcher status initiation may be a valuable tool to monitor and assess patients at higher risk for acute decompensation.
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