title: Implementation of an in situ qualitative debriefing tool for resuscitations.
abstract: OBJECTIVE
  Multiple guidelines recommend debriefing of resuscitations to improve clinical performance. We implemented a novel standardized debriefing program using a Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) tool.
  
  
  METHODS
  Following the development of the evidence-based DISCERN tool, we conducted an observational study of all resuscitations (intubation, CPR, and/or defibrillation) at a pediatric emergency department (ED) over one year. Resuscitation interventions, patient survival, and physician team leader characteristics were analyzed as predictors for debriefing. Each debriefing's participants, time duration, and content were recorded. Thematic content of debriefings was categorized by framework approach into Team Emergency Assessment Measure (TEAM) elements.
  
  
  RESULTS
  There were 241 resuscitations and 63 (26%) debriefings. A higher proportion of debriefings occurred after CPR (p<0.001) or ED death (p<0.001). Debriefing participants always included an attending and nurse; the median number of staff roles present was six. Median intervals (from resuscitation end to start of debriefing) & debriefing durations were 33 (IQR 15, 67) and 10 min (IQR 5, 12), respectively. Common TEAM themes included co-operation/coordination (30%), communication (22%), and situational awareness (15%). Stated reasons for not debriefing included: unnecessary (78%), time constraints (19%), or other reasons (3%).
  
  
  CONCLUSIONS
  Debriefings with the DISCERN tool usually involved higher acuity resuscitations, involved most of the indicated personnel, and lasted less than 10 min. Future studies are needed to evaluate the tool for adaptation to other settings and potential impacts on education, quality improvement programming, and staff emotional well-being.
authors.affiliation: Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA. mullan20@gmail.com
authors.forename: Paul C
authors.initials: PC
authors.lastname: Mullan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wuestner
authors.forename: Tarra D
authors.initials: TD
authors.lastname: Kerr
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Christopher
authors.forename: Binita
authors.initials: B
authors.lastname: Patel
mesh_terms: D016887:Cardiopulmonary Resuscitation; D002983:Clinical Competence; D015331:Cohort Studies; D003142:Communication; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital; D005246:Feedback; D006801:Humans; D010348:Patient Care Team; D010372:Pediatrics; D058996:Quality Improvement; D012189:Retrospective Studies