Debriefing and Cardiac Arrest Quality Improvement NCEMSF

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“Debriefing of cardiac arrest events, either in isolation or as part of an organized response system, improves subsequent CPR performance in-hospital and results in higher rate of return of spontaneous circulation (ROSC). Debriefing of actual resuscitation events can be a useful strategy to improve future performance (Class IIa, LOE C). Additional research on how best to teach and implement post event debriefing is warranted.”

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  • Address minutes
  • Hard data and anecdotal
  • Punative
  • Debriefing and Cardiac Arrest Quality Improvement NCEMSF

    1. 1. DEBRIEFINGANDCARDIAC ARRESTQUALITY IMPROVEMENT David Hiltz, NREMT-P Mike Smith, MPH, EMT-B American Heart Association Emergency Cardiovascular Care Programs
    2. 2. OBJECTIVES
    3. 3. ANOBVIOUS INFLUENCE
    4. 4. HOUSTON, WE DO HAVE A PROBLEM!
    5. 5. PROBLEMS AT A GLANCE PART 1
    6. 6. PROBLEMS AT A GLANCE PART 2
    7. 7. The DISPARITY
    8. 8. SURVIVAL TO DISCHARGE“IS ALL OVER THE MAP”
    9. 9. BUT NOT ANUNSOLVABLEPROBLEM!
    10. 10. DEVELOPING A CULTURE OF EXCELLENCE
    11. 11. BASTARD I HATELIFESAVER WAITIN DAMN S G! EMTS
    12. 12. A NECESSARY COMBINATION!
    13. 13. A QUICK WORD… CAN’T WE SOLVE OURPROBLEMS WITH TECHNOLOGY? A COMMON MISCONCEPTION!
    14. 14. DEBRIEFING IS CHEAP!
    15. 15. Debriefing of cardiac arrest events, either in isolation or as part of an organized response system, improves subsequentCPR performance in-hospital and results in higher rate of return of spontaneous circulation (ROSC). Debriefing of actual resuscitation events can be a useful strategy to improve future performance (Class IIa, LOE C).
    16. 16. Innovative concepts to reduce the decay ofskills and knowledge may include continuous maintenance of competency programs that employ frequent short-duration interactions with content and skills after an initial course, or they may include guided debriefings after real-life events that focus on response improvement.
    17. 17. Debriefing is a learner- focused, nonthreatening technique to assist individual rescuers or teams to reflect on, and improve, performance. In manikin-based studies, debriefing as part of the learningstrategy resulted in improved performance in post-debriefing simulated scenarios, and it improved adherence to resuscitation guidelines in clinical settings. Debriefing as a technique to facilitate learning should be included in all advanced life support courses (Class I, LOE B).
    18. 18. Structured and Supported Debriefing Our Definition! A provider‐centric process designed to standardize the debriefing process to assist clinicians in thinking about what they did, how they did it, and how they can improve.
    19. 19. A provider-centered approachemphasizes self-discovery and self-critique. A provider-centered approach also draws upon professional experience and motivation to perform well to enhance performance and outcomes.
    20. 20. Thoughtful discussion after an attempted resuscitation is important to facilitate the sorting out of events as well as gaining insight on what happened and whyWe often learn better through self‐discovery and self‐analysis than by other methods!
    21. 21. PROVIDERS NEED TO EXPRESS THEMSELVES AND THEIR FEELINGS…AND THIS IS A GREAT FORUM FOR THAT!
    22. 22. IMPLEMENTATION •Have long term view •Patients and patience•INSTANT GRATIFICATION!
    23. 23. Structured and Supported Debriefing Supported elements include both interpersonal support as well as use of protocols, algorithms, and best evidence to inform debriefing statements/questions.
    24. 24. Team leader trained in Structured and SupportedDebriefings
    25. 25. ROLE OF FACILITATOR•PROVIDE SAFE ENVIRONMENT FOR SHARING EXPERIENCES •DRAW OUT INFORMATION AND EXPERIENCES•CONTENT DIRECTED BY THE CREW •NEVER JUDGE!
    26. 26. Gather, Analyze, Summarize
    27. 27. Structured and Supported DebriefingStructured elements include three specific debriefing phases with related goals, actions, and time estimates.
    28. 28. USE UNTAPPEDDATA!
    29. 29. INSTRUMENTEDMANIKINS
    30. 30. ANECDOTAL EVIDENCE NUMERICAL DATA
    31. 31. NOT PUNATIVE!
    32. 32. PIZZA DIPLOMACY!
    33. 33. BOY, I AM REALLY LOOKING FORWARD TO THEDEBRIEFING ON THIS CASE!
    34. 34. PRACTICE MAKES PERFECT!
    35. 35. THROUGH TEAMWORK,TRAINING AND EDUCATION,STRETCH FOR EXCELLENCE!
    36. 36. Be the change you want tosee in the world.-Ghandi

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