We Need to Talk

Background: Debrief following significant clinical incidents is widely recognized as good medical practice as it can improve both patient safety and supports staff wellbeing. Yet in practice there are many barriers to implementing debrief.

Objective: To assess current practice regarding debriefs following paediatric resuscitations at a district general hospital (DGH), identify barriers preventing debriefs from occurring, and implement strategies to overcome these.

Methods: An anonymised survey was completed by members of the paediatric nursing, medical and healthcare teams between Mar 25 to April 25, 2020.

Results: The survey was completed by 36 members of staff. On average, respondents had attended over 10 “difficult resuscitations or significant clinical events” during their time at this DGH. Yet they only participated in, on average, less than 2 debriefs. The results showed 50% of staff had experienced a situation where they felt a debrief would have been beneficial, but one was not offered. Debriefs were most often led by a consultant or sister. The main barriers to a debrief were time constraints due to ward pressures, lack of a “leader” or person with debrief experience. Only 11% of staff felt confident leading a debrief, with 43% wanting formal training in this.

Conclusion: Debriefs following acute events in paediatrics are beneficial to staff wellbeing, learning from incidents, and patient safety. Key issues with performing debriefs were time pressures and lack of trained staff to facilitate them. To overcome these barriers, it has become mandatory for paediatric consultants to attend debrief training at the regional tertiary hospital. Guidelines to support discussion facilitators are now available. New staff inductions now focus on empowering staff to ask for debriefs. We will shortly review the effect of these implementations. Going forward we aim for continued openness amongst staff following acute critical scenarios to encourage positive dialogue.