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. 2021 Oct;33(5):780-787.
doi: 10.1111/1742-6723.13813. Epub 2021 Jul 10.

Debriefing immediately after intubation in a children's emergency department is feasible and contributes to measurable improvements in patient safety

Domenic R Cincotta  1   2   3 , Nuala Quinn  1   2 , Joanne Grindlay  1   2   3 , Stefano Sabato  2   4 , Emmanuelle Fauteux-Lamarre  1 , David Beckerman  1   5 , Terry Carroll  1   2   5 , Elliot Long  1   2   3   6
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Debriefing immediately after intubation in a children's emergency department is feasible and contributes to measurable improvements in patient safety

Domenic R Cincotta et al. Emerg Med Australas. 2021 Oct.

Abstract

Objective: In 2013, our intubations highlighted a safety gap - only 49% achieved first-pass success without hypoxia or hypotension. NAP4 recommended debriefing after intubation, but limited published methods existed. Primary aim is to implement a feasible process for immediate debriefing and feedback for emergency airway management. Secondary aims are to contribute to reduced frequency of adverse intubation-related events and implement qualitative improvements in patient safety through team reflection and feedback.

Methods: A component of a prospective quality improvement (QI) study over 4 years in the ED of the Royal Children's Hospital, Melbourne, Australia. Debrief and feedback after intubation was one of seven study interventions. Targeted staff training and involvement of departmental leaders occurred. A post-intervention cohort was audited in 2016. Analysis included the Team Emergency Assessment Measure.

Results: Immediate post-event debriefing occurred in 39 (85%) of 46 intubations. Debriefing was short (median duration 5 min, interquartile range [IQR] 5-10) and soon after (median time 20 min, IQR 5-60). Commonest location was the resuscitation room (92%), led by the team leader (97%). Commonest barrier preventing immediate debriefing was excessive workload. Two QI process measures were assessed during debriefing (adequate resuscitation, airway plan) and case summaries distributed for 100% of intubations. Performance outcomes included contribution to 78% first-pass success without hypoxia or hypotension. Team reflection prompted changes to environment (signage, stickers), training (skill drills), teamwork and process (communication, clinical event debriefing).

Conclusion: Structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety.

Keywords: child; clinical debriefing; intubation; patient safety; team reflection.

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References

    1. Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit Project. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 2: intensive care and emergency departments. Br. J. Anaesth. 2011; 106: 632-42.
    1. Long E, Sabato S, Babl FE. Endotracheal intubation in the pediatric emergency department. Paediatr. Anaesth. 2014; 24: 1204-11.
    1. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 1: anaesthesia. Br. J. Anaesth. 2011; 106: 617-31.
    1. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013; 84: 1500-4.
    1. Schwartz DE, Matthay MA, Cohen NH. Death and other complica- tions of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995; 82: 367-76.

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