cold debriefs: a tool for quality improvement &...
TRANSCRIPT
Cold Debriefs: a tool for Quality Improvement & Learning
Dr E Pitt, Dr R Alcock, SCN G Fotheringham, Dr K Jacques – Emergency Department, Forth Valley Royal Hospital
Introduction & Aim Learning, sharing and applying lessons
is central to a system dedicated to
patient safety and improving quality of
care. There are many formats such as
Root cause analysis, Morbidity &
mortality meetings and Serious adverse
event reviews. None of these provide a means for the actual team
members involved to review a specific case they cared for in order to
create, share and act on learning specific to our setting. We have developed
a reproducible and standardised format for running Cold Debriefs
following any case in the Emergency Department (ED) that is felt worthy
of review by any member of the team. Our objective is to improve patient
outcomes and safety
using timely feedback
and reflection by the
team involved.
Methods Over 7 years we have
run more than 28 Cold
debriefs facilitated by
Emergency Medicine
Consultants & Nurses. Through an iterative process a standardised format
has been developed and agreed. The process is followed from the
moment a case is nominated by ANY member involved in any case in the
Emergency Department. This multispecialty, multidisciplinary pathway
continues until the final Learning and Action Points have been collated,
shared and acted on with all relevant hospital departments and pre-hospital
services.
Types of Cases
Results The cold debriefs have resulted in multiple technical,
non-technical and human factor changes. Examples
of these are shown in the photographs.
The benefits of cold debriefs
have been recognised and
adopted elsewhere within our
own and neighbouring hospitals.
Staff Feedback Although the primary aim is organisational learning
and quality improvement, staff feedback also indicates
valuable personal learning, reflection and peer
support.
When surveyed in 2015 80.5%
ED staff stated that they wanted
cold debriefs as part of the formal
ED feedback & support mechanism.
Some of our cold debriefs have also been initiated by Non-NHS
Emergency responders. These debriefs are now recognised as standard
practice by FVRH Emergency Department staff.
Next Steps & Limitations Cold Debriefs are time consuming to arrange & write up. It is possible
they may trigger adverse psychological response (but we are not aware of
any). In future, we would like to train more facilitators, further refine the
process of running a debrief, quality assure the completion of Action
Points and sharing of Learning Points, share this practice with other
departments that are interested in developing their own Cold Debriefs and
conduct research on impact on staff well-being.
References Kessler D et al. Debriefing in the ED after clinical events:
A practical guide. Ann Emerg Med. 2014; 10:1-9
For more information please contact [email protected]
Paediatric death or critical illness: 16
SUDI, Asthma, Drowning, Non
accidental injury, Major trauma
Adult death or critical illness: 5
Fatal Burns, Sepsis, Difficult Airway, Major Trauma,
Chemical Decontamination
Obstetric: 4
Perimortem C/Section, Major Trauma, Stillbirth
Multi-casualty incidents: 3
Road traffic collisions
“This was a difficult challenge for me and
demonstrated how the Ambulance Service
and Accident & Emergency
personnel provide the utmost frontline
pre-hospital, Accident and Emergency care
in challenging environments. The cold
debrief offered closure and on reflection
highlighted the importance of sharing
information pertaining to the incident”
Conclusions • ED staff can deliver multidisciplinary/multiagency/multispecialty cold
debriefs for the hospital.
• Cold debriefs inform improvements on quality of care as well as
learning on structures and processes.
• Cold debriefs may help staff well-being but this requires further
research.