Implementing clinical event debriefing to improve patient care

Background The Advocate Children’s Hospital Neonatal/Pediatric Transport Team (ACHTT) transports approximately 2,000 neonatal/pediatric patients each year within the Advocate Children’s Hospital and Northshore system. Opportunities have been identified to improve feedback on transports completed. Debriefing is associated with improved outcomes, improved team performance, and provides the opportunity to discuss gaps in clinical knowledge, performance, and behaviors. Debriefing also provides the opportunity for group reflection and examination of teamwork. Local Problem No process existed to formally debrief after a transport completed by the ACHTT. The need to create a multidisciplinary clinical debriefing program was identified. Method A review of literature was performed to identify best practices for clinical event debriefing. Key stakeholders were identified and involved in the development of the multidisciplinary ACHTT clinical event debriefing program. A defined process and tools to guide the teammates through debriefing were developed. Nurses, respiratory therapists, physicians, paramedics, and dispatch assistants were educated prior to implementation. A pre- and six-month post implementation survey was completed by ACHTT team members to evaluate the teamwork and level of support received during a transport call. Results/Conclusions An improvement in teamwork and support was reported six months post-implementation for the six questions; a) receiving adequate follow up on transports (28% to 75%), b) feeling supported to identify areas of optimal clinical performance (64% to 75 %), c) feeling supported to identify areas of suboptimal performance (60% to 68.8%), d) being given the opportunity for reflection of knowledge, skills, and attitudes of a transport call (36% to 87.5%), e) discussion on interdisciplinary teamwork (36% to 87.5%), and f) opportunities to determine ways to improve future performance (44% to 75.1%). Through implementing a formal debriefing process, teammates felt a greater sense of teamwork and support received. Many process improvements have resulted from the debriefing process including equipment changes and transport protocol revisions