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Randomized Trial To Compare the Efficacy
of Participant-Led vs
Facilitator-Led Debriefing
Paul Mullan (Children’s National...
Background
• Debriefing resuscitations is recommended
– Frontline providers: rarely done (6-27%)1,2,3

• Multiple debriefi...
PICO Question
• P: For medical providers after a simulated resuscitation,
• I: is a participant-led structured debriefing ...
Design
• Multi-center (3-6 institutions?)

• Subjects: pediatric providers (attendings, trainees, & nurses)
– Participant-...
Intervention & Randomization
• Participant-Led Debrief (PLD) or Facilitator-Led Debrief (FLD)
• Randomization into two gro...
Design: Outcomes
• Performance: Blinded video review
• Clinical performance : Clinical Performance Tool (CPT)1
• Teamwork/...
Contact Information
Name:

Paul C. Mullan, MD, MPH

Institution:

Children’s National Medical Center / GW

E-mail:

mullan...
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Alert 2014-new-mullan2

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Alert 2014-new-mullan2

  1. 1. Randomized Trial To Compare the Efficacy of Participant-Led vs Facilitator-Led Debriefing Paul Mullan (Children’s National Medical Center) Adam Cheng (University of Alberta), David Kessler (Columbia) INSPIRE @ IMSH 2014: San Francisco International Network for Simulation-based Pediatric Innovation, Research and Education
  2. 2. Background • Debriefing resuscitations is recommended – Frontline providers: rarely done (6-27%)1,2,3 • Multiple debriefing models exist – American Heart Association, 3D Model, Plus/Delta, SHARP, DISCERN, Debriefing with Good Judgment, Advocacy/Inquiry,... • Debriefing barriers4: – Time (90%) & lack of trained facilitators (45%) Can we get frontline providers to debrief in a consistent, timely, and effective manner without any training in debriefing? 1Sandhu, 2013. 2Ireland, 2008. 3Hayes, 2007. 4Sandhu, 2013. International Network for Simulation-based Pediatric Innovation, Research and Education
  3. 3. PICO Question • P: For medical providers after a simulated resuscitation, • I: is a participant-led structured debriefing significantly different • C: than a facilitator-led structured debriefing at • Outcomes: 1.Improving clinical & behavioral team performance (in a second simulated resuscitation) 2. Identifying & addressing key performance gaps 3. Achieving provider satisfaction with the debriefing International Network for Simulation-based Pediatric Innovation, Research and Education
  4. 4. Design • Multi-center (3-6 institutions?) • Subjects: pediatric providers (attendings, trainees, & nurses) – Participant-led: physician team leader + nurse team leader – Facilitator-led: simulation instructors • Setting: simulation center or in-situ • Scenarios: two cardiac arrests in the emergency department • Debriefing model: standardized form (no video review)1 – Scripted ground rules – Plus (“What went well?”) – Delta (“What could have gone better & what would we need to change?”) • Debriefing training: none 1Mullan, 2013 International Network for Simulation-based Pediatric Innovation, Research and Education
  5. 5. Intervention & Randomization • Participant-Led Debrief (PLD) or Facilitator-Led Debrief (FLD) • Randomization into two groups, 5 segments: – Group A: Arrest #1  PLD  Arrest #2  FLD  Survey – Group B: Arrest #1  FLD  Arrest #2  PLD  Survey • Duration: – 10 minutes per segment – 1 hour total allotted time International Network for Simulation-based Pediatric Innovation, Research and Education
  6. 6. Design: Outcomes • Performance: Blinded video review • Clinical performance : Clinical Performance Tool (CPT)1 • Teamwork/CRM performance: Team Emergency Assessment Measurement (TEAM) tool2 or Behavioral Assessment Tool (BAT)3 • Debriefing quality: un-blinded review • • Debriefing Assessment for Simulation in Healthcare (DASH)4; modifications? Addressing performance gaps identified in the performance measures above • Qualitative assessment: survey or interviews: • Debriefing tool usability, satisfaction, sustainability, safety/harms • Process measures: • Debriefing duration, degree of team participation in debriefing, others… 1Donoghue, 2011, 2Cooper, 2010, 3LeFlore, 4Rudolph, 2007 International Network for Simulation-based Pediatric Innovation, Research and Education
  7. 7. Contact Information Name: Paul C. Mullan, MD, MPH Institution: Children’s National Medical Center / GW E-mail: mullan20@gmail.com Phone: +1-713-855-4827 Collaborators: Adam Cheng, MD (University of Alberta) David Kessler, MD, MSc (Columbia University) International Network for Simulation-based Pediatric Innovation, Research and Education

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