In the pediatric hospital medicine setting, we have all encountered a case that has stuck with us throughout the day, that follows us outside the hospital, that swirls around in our heads as we go to sleep. Alternatively, many of us have experienced a situation we prefer to actively avoid or compartmentalize in a box locked away in a closet. Whether we like it or not, the safety of our patients, our psychological wellbeing, and our trainees’ learning all depend on effectively processing difficult events and improving upon past decisions. In a standardized debriefing process, we allow this messy internal dialogue (or maybe lack there-of) to materialize in an organized group setting, one where tangible conclusions can come to light and result in actionable change. With their quality improvement project, “Post-Clinical Event Debriefings,” Solomon et al. strive to do exactly this by creating a sustainable debriefing process (10.1542/hpeds.2023-007452).
We can all imagine the barriers to getting team members together at the same time in a busy clinical day. Time is one of the biggest factors, as well as competing clinical responsibilities and obtaining buy-in from team members. With these barriers in mind, the authors devised a 20-month study with 5 PDSA cycles and 2 main aims:
- Obtaining 75% completion rate of debriefs for Medical Emergency Team events or Codes on the PHM services at their institution, and
- Maintaining a debrief duration less than 10 minutes.
They developed a key driver diagram to uncover their primary and secondary drivers to achieving these aims, including having a standardized debriefing process with facilitator scripts and quick access to an online debriefing form. They also ensured that documentation was easy and accessible, and that important team members, or “core members,” were present for the debrief. Importantly, in developing an effective debrief protocol, they obtained input from a diverse task force, including nursing directors, charge nurses, attendings, and residents who all have unique perspectives in a debrief session. With each PDSA cycle, they identified areas of improvement and balanced efficiency and thoroughness, prioritizing psychological safety and team members’ wellbeing while also trying to increase their participation rate and shorten duration.
In the 20 months of the study, the authors found that debriefs occurred 66% of the time, coming very close to the goal of 75%. Their run chart reveals sustained change in debriefing rates, and they achieved their second aim with a median debriefing time of 7 minutes. Additionally, via quantitative surveys post implementation, most members felt the debriefs were useful. These numbers show us that implementing and sustaining the habit of debriefing efficiently is entirely feasible. In my opinion, we can no longer blame lack of time as a reason for skipping this important learning opportunity. Although challenging to measure, it would be interesting to see the effectiveness of these short debriefs, perhaps in mitigating burnout or changing clinical outcomes. In the end, I am a firm believer that taking 10 minutes now can save us a difficult 30 minutes later.
