Debriefing immediately after intubation in a children's emergency department is feasible and contributes to measurable improvements in patient safety.
OBJECTIVE
In 2013, our intubations highlighted a safety gap - only 49% achieved first-pass success without hypoxia or hypotension. NAP4 recommended debriefing after intubation, but limited published methods existed. Primary aim is to implement a feasible process for immediate debriefing and feedback for emergency airway management. Secondary aims are to contribute to reduced frequency of adverse intubation-related events and implement qualitative improvements in patient safety through team reflection and feedback.


METHODS
A component of a prospective quality improvement (QI) study over 4 years in the ED of the Royal Children's Hospital, Melbourne, Australia. Debrief and feedback after intubation was one of seven study interventions. Targeted staff training and involvement of departmental leaders occurred. A post-intervention cohort was audited in 2016. Analysis included the Team Emergency Assessment Measure.


RESULTS
Immediate post-event debriefing occurred in 39 (85%) of 46 intubations. Debriefing was short (median duration 5 min, interquartile range [IQR] 5-10) and soon after (median time 20 min, IQR 5-60). Commonest location was the resuscitation room (92%), led by the team leader (97%). Commonest barrier preventing immediate debriefing was excessive workload. Two QI process measures were assessed during debriefing (adequate resuscitation, airway plan) and case summaries distributed for 100% of intubations. Performance outcomes included contribution to 78% first-pass success without hypoxia or hypotension. Team reflection prompted changes to environment (signage, stickers), training (skill drills), teamwork and process (communication, clinical event debriefing).


CONCLUSION
Structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety.
['Cincotta|Domenic R|DR|0000-0001-7435-4037', 'Quinn|Nuala|N|0000-0002-7725-7678', 'Grindlay|Joanne|J|', 'Sabato|Stefano|S|', 'Fauteux-Lamarre|Emmanuelle|E|', 'Beckerman|David|D|', 'Carroll|Terry|T|', 'Long|Elliot|E|0000-0003-0225-7953']
D002648:Child D002983:Clinical Competence D004636:Emergency Service, Hospital D006801:Humans D007442:Intubation, Intratracheal D061214:Patient Safety D011446:Prospective Studies D058996:Quality Improvement
intubation patient safety team reflection child clinical debriefing