P3 The development and implementation of a hot debriefing tool with the use of simulation

Abstract

Background A hot debrief is a review carried out ‘there and then’ following an incident to ensure improved recall and full team participation. Several international guidelines recommend implementing a hot debriefing process to aid quality improvement and workforce morale following treatment of critically ill patients. Despite this, there are no standardised debriefing guidelines available. We aimed to use simulation scenarios to design and implement an efficient hot debriefing tool for MDT teams treating critically ill patients in our department. Summary of project We designed common scenarios seen in our resuscitation room. The scenarios included; severe asthma, chest trauma, major haemorrhage, difficult airway, overdose, massive PE and Stroke. Participants included nursing, medical and other healthcare staff. The scenarios took place in-situ and during weekly department teaching sessions. We followed each scenario by an immediate team debrief. Participant’s feedback was recorded to help design our hot debriefing tool. We used further scenarios to introduce the tool and to make ongoing changes. Since its introduction to the department floor we have kept record of issues highlighted, made appropriate changes and given closed loop feedback to ensure ongoing department improvement. Summary of results We have designed a two page hot debriefing tool for use immediately following treatment of critically ill patients. The tool focuses on pre briefing, ‘ABC’ technical skills, communication, documentation and equipment. Since its introduction we have made changes to team pre-briefing from ambulance control, resus equipment, lab processing, technical arrest skills and employee access to psychological support services. We have recorded qualitative feedback from staff highlighting the tool’s importance in both personal and team development. Discussion and conclusion We have developed a concise and efficient hot debriefing tool which has led to department changes in the management of critically ill patients. The use of simulation to design the tool helped highlight key areas to include. MDT simulation scenarios ensured full department ownership and awareness of the hot debriefing process. We aim to introduce this tool hospital wide with the use of further simulation scenarios during medical team inductions. Recommendation We recommend all emergency department to use simulation in order to design and implement hot debriefing processes. References 2015 Institute of Medicine (IOM) Report - Strategies to Improve Cardiac Arrest Survival: A Time to Act. 2015 AHA, Advanced cardiac life support guidelines.