Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric Emergency Department.

Abstract

Introduction: Multidisciplinary clinical debriefs are structured discussions following critical events to assess performance, identify improvement opportunities, and provide team support. Despite known benefits, debriefs are underused. We aimed to increase debrief completion following pediatric emergency department (ED) cardiac arrests and endotracheal intubations. The primary outcome was the percentage of critical events with a completed debrief form. To assess potential workflow disruptions, we assessed 2 balancing measures: room-to-provider and door-to-provider times among Emergency Severity Index level 1 and 2 patients.

Methods: A key driver diagram guided targeted interventions. We implemented a standardized Research Electronic Data Capture (REDCap) debrief form using a plus-delta framework with scripted prompts, accessible via quick response codes throughout the ED. As part of the intervention design, debriefs were encouraged within 30 minutes of the event and were designed to last 7 minutes or less. Educational initiatives included staff meetings, email reminders, newsletters, signage, and designated nursing champions. We used statistical process control to assess changes over time.

Results: Debrief completion increased from 4% to 52% during 15 months, showing special-cause variation. Median room-to-provider times remained unchanged. Median door-to-provider times decreased during the intervention period.

Conclusions: Multiple interventions significantly increased the use of structured debriefing without adversely affecting patient flow. Structured debriefing is both feasible and sustainable in high-acuity ED settings, particularly when supported by ongoing education and active team engagement.