Are Residents Willing to Participate in Performance Review and Debriefing Following Resuscitation Events? A Quality Improvement Survey and Learning Needs Assessment
CCCF ePoster library. Moliner P. Nov 8, 2018; 233411
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Dr. Peter Moliner
Dr. Peter Moliner
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Abstract
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Introduction:    ACLS guidelines recommends performance review and debriefing as part of the process of continuous improvement and performance enhancement1.   Our resuscitation teams do not routinely review performance or debrief; this reflects the situation elsewhere across Canada.  This results in missed opportunities for addressing performance gaps which may have occurred during the event.  We proposed a Quality Improvement (QI) initiative which involves 3 components: sensitization to deficiencies during resuscitation, multi-source feedback for performance review and scheduled cold debriefing.

Objectives:  This survey evaluated the willingness of residents to participate process of quality improvement in resuscitation care which would include performance review of real life resuscitation practice and determine their learning needs in  debriefing.

Methods:  Residents were surveyed after obtaining REB approval at the Université de Sherbrooke. A presentation of scientific evidence was offered2, 3, 4 and we then explored attitudes  in five categories using a mixed method technique (24 questions using a five point Likert scale and allowing commentary).

Results:(SeeTable 1)The adjusted response rate was approximately 39%. Very few residents had never been exposed to a resuscitation situation and 97% had at least observed an event. Of those, 80% had assisted in a resuscitation and half had led a resuscitation.   

1) Is it a good idea? Almost all respondents agreed that there was potential to improve patient care by way of a QI initiative. All respondents either agreed (22%) or strongly agreed (78%) that participation in debriefing of events would improve their own learning.

2) What should be the focus?  All four elements—noting of errors, adherence to algorithms, clarity in assigning roles and quality of communication—received strong support. 

3) Feasibility: There was substantial agreement with regard to the feasibility of instituting all six of the measures proposed by the QI proposal. Establishing the timing of medications and a working diagnosis (or defibrillation), filling out a preliminary report and distributing evaluation cards all received greater than 80% approval. There was skepticism with respect to the idea of assigning of a spotter to evaluate chest compression quality (20%) and cold debriefing.

4) Concerns:   Information recall, logistics, and time constraints were all seen as a potential problems with cold debriefing.  Feedback cards were considered acceptable. There was strong agreement (98%) that debriefing can be carried out in a positive and respectful environment. However, 53% agreed that it could be intimidating. Comments suggest that residents apprehend poor debriefing, not debriefing itself. Few perceived medico-legal concerns seen as an obstacle (20%).

5) Learning Needs:   A strong majority agreed that they had unmet needs and expressed an interest in debriefing training using any method (documentation,  online interactive module and debriefing training using simulation).

Conclusion: :  Residents are clearly in favour of a QI initiative in resuscitation and are willing to participate.  An unintended consequence of the initiative is the creation of a framework whereby all participants can evaluate a resuscitation and supports standardizing those elements which require attention during performance review.5 This survey justifies going forward with a QI initiative which includes training residents on how to carry out debriefing following resuscitation based on existing science and educational theory.                         


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