Recently, David Baumrind of East Hampton, NY and I began talking about various strategies to improve resuscitation outcomes. As part of those discussions, we talked about debriefing and how it could be used to help improve the quality of resuscitation being provided, as well as sharing our perspectives on the subject.
Debriefing and Cardiac Arrest Quality Improvement NCEMSFDavid Hiltz
“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.”
The Use of Structured and Supported Debriefing in Cardiac Arrest Quality Impr...David Hiltz
Hiltz and Baumrind discuss the use of the American Heart Association's Structured and Supported Debriefing program and how it can be used in a clinical environment as part of strategies to improve resuscitation quality.
Critical Incident Stress Debrief Literature Reviewdaniellesmith
This literature review examines the effectiveness of critical incident stress debriefings (CISDs) in reducing PTSD symptoms following traumatic events. The review found that studies have produced inconsistent results due to variations in what constitutes a traumatic event, the timing of CISDs, and how outcomes are measured. CISDs were most effective when conducted within 24-72 hours according to the standard model, and with consistent assessment methods. Future research with strict criteria is still needed to accurately determine if CISDs can help prevent PTSD in situations like military combat.
The document provides an overview of critical incident stress management (CISM) and its goals of preventing and mitigating stress from traumatic events. CISM uses various interventions like education, defusing sessions, and critical incident stress debriefings to help individuals and groups cope with stress in the aftermath of critical incidents. The document outlines the different types of CISM interventions and their objectives, emphasizing that CISM is a comprehensive program aimed at supporting the overall well-being of personnel exposed to trauma.
Critical Incident Stress Management and EAPPete Hanlon
This document provides information about critical incident stress management and employee assistance programs. It discusses how traumatic events can cause strong emotional reactions in responding personnel. Common signs and symptoms of stress reactions are outlined, including physical, cognitive, emotional and behavioral impacts. Guidelines are provided for coping within the first 24-48 hours after an incident. The document also describes how friends and family can support someone experiencing a stress reaction and where to find help through employee assistance programs like Ohio's.
This document provides information on forming effective teams in healthcare settings. It discusses the importance of teams and defines what constitutes a team. Characteristics of effective teams include shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes. Barriers to effective teamwork include dysfunction, mistrust, and poor communication. Facilitators include well-defined goals and objectives, selecting members based on skills, having defined roles for each member, developing mutual respect and trust, and effective management. The document also discusses team inputs like structure, composition, and leadership as well as processes like conflict management, communication, and shared mental models that influence outcomes like performance and satisfaction.
The NA should have told the RN about the medication left on the bedside table so the RN was aware of the situation and could properly assess and treat the patient. Throwing the medication away without informing the RN put the patient's safety at risk.
Debriefing and Cardiac Arrest Quality Improvement NCEMSFDavid Hiltz
“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.”
The Use of Structured and Supported Debriefing in Cardiac Arrest Quality Impr...David Hiltz
Hiltz and Baumrind discuss the use of the American Heart Association's Structured and Supported Debriefing program and how it can be used in a clinical environment as part of strategies to improve resuscitation quality.
Critical Incident Stress Debrief Literature Reviewdaniellesmith
This literature review examines the effectiveness of critical incident stress debriefings (CISDs) in reducing PTSD symptoms following traumatic events. The review found that studies have produced inconsistent results due to variations in what constitutes a traumatic event, the timing of CISDs, and how outcomes are measured. CISDs were most effective when conducted within 24-72 hours according to the standard model, and with consistent assessment methods. Future research with strict criteria is still needed to accurately determine if CISDs can help prevent PTSD in situations like military combat.
The document provides an overview of critical incident stress management (CISM) and its goals of preventing and mitigating stress from traumatic events. CISM uses various interventions like education, defusing sessions, and critical incident stress debriefings to help individuals and groups cope with stress in the aftermath of critical incidents. The document outlines the different types of CISM interventions and their objectives, emphasizing that CISM is a comprehensive program aimed at supporting the overall well-being of personnel exposed to trauma.
Critical Incident Stress Management and EAPPete Hanlon
This document provides information about critical incident stress management and employee assistance programs. It discusses how traumatic events can cause strong emotional reactions in responding personnel. Common signs and symptoms of stress reactions are outlined, including physical, cognitive, emotional and behavioral impacts. Guidelines are provided for coping within the first 24-48 hours after an incident. The document also describes how friends and family can support someone experiencing a stress reaction and where to find help through employee assistance programs like Ohio's.
This document provides information on forming effective teams in healthcare settings. It discusses the importance of teams and defines what constitutes a team. Characteristics of effective teams include shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes. Barriers to effective teamwork include dysfunction, mistrust, and poor communication. Facilitators include well-defined goals and objectives, selecting members based on skills, having defined roles for each member, developing mutual respect and trust, and effective management. The document also discusses team inputs like structure, composition, and leadership as well as processes like conflict management, communication, and shared mental models that influence outcomes like performance and satisfaction.
The NA should have told the RN about the medication left on the bedside table so the RN was aware of the situation and could properly assess and treat the patient. Throwing the medication away without informing the RN put the patient's safety at risk.
Amputation is the removal of a limb or part of a limb by a surgical procedure in order to save the life of a person. Amputation is a triple threat. It involves loss of function, loss of sensation, and loss of body image.
The document discusses guidance and counseling provided to 5 employees. It describes various techniques used in the counseling process, including observation, autobiographical sketches, anecdotal records, case studies, cumulative records, and questionnaires. For each employee, the document outlines the specific technique used, how it was implemented, and what information it provided about the employee to help with counseling. The overall purpose of the counseling and guidance was to address work-related issues like lack of promotion and cultural biases, in order to lessen conflicts and create a more sustainable work culture.
A Journey Towards Physical Fitness and Awareness: Applying the TTM to Modify...Elisah Mugwagwa
This document describes one woman's personal journey to improve her physical fitness and wellness through applying the Transtheoretical Model of behavior change to exercise. It introduces the Transtheoretical Model, which describes stages of behavior change, and explains how the woman used it to structure her exercise goals and track her progress over 7 weeks. Through self-monitoring and goal setting based on the model's components, she was able to gradually increase her exercise time and frequency each week from an initial 3 days per week to exercising daily by the 7th week. The document concludes by noting that while the Transtheoretical Model helped structure her exercise program, maintaining well-being requires more than just exercise.
This article discusses integrating mindfulness into the workplace to reduce stress. It begins by providing context on the mindfulness-based stress reduction (MBSR) program and how it has helped over 8,000 people. It then outlines 21 strategies for reducing stress during the workday through mindfulness practices like conscious breathing. A story is shared about a physician who used green dots as reminders to take a mindful breath and relax his shoulders 100 times in a day, which helped transform his experience of stress at work. The article advocates for using everyday cues in the workplace to remind oneself to be mindful.
The document discusses factors that influence self-care behaviors in heart failure patients. It identifies that motivation, knowledge, and barriers like fatigue can impact self-care. Nurse responsibilities include removing barriers and improving patient education. Tools for improving patient knowledge include telephone education, web-based learning, and video education. The document also outlines a plan-do-study-act model for testing behavior changes and improving patient motivation.
The document describes the Stress Management Questionnaire (SMQ) and Stressmastery Guide developed by Dr. James Petersen. The SMQ is an 87-item assessment that measures stress levels across 11 scales. It has been taken by over 600,000 individuals worldwide. After completing the SMQ, individuals receive the Stressmastery Guide, a 41-page workbook that provides suggestions for reducing stress based on their personal results. The SMQ and Guide can be used together in stress management programs, seminars, and for individual self-help.
A Nursing Leadership Guide: Communication, Teamwork, Mutual Support, Conflict...Ahmad Amirdash
This document provides an overview of a presentation on nursing leadership and effective communication. The presentation objectives are to help understand the importance of effective communication, identify barriers to communication, and apply tools to improve teamwork, communication, conflict resolution, and patient safety. Effective communication involves being complete, clear, brief and timely. Barriers to team effectiveness include team composition, working conditions, and resources. Positive outcomes of effective teamwork include reduced length of stay, higher quality care, better patient outcomes, and improved staff satisfaction. Strategies for effective communication, teamwork and conflict resolution include advocacy and assertion, the two-challenge rule, DESC script, CUS, feedback, task assistance, I'm Safe, collaboration, handoffs, situation monitoring
The document discusses decision making in sports rehabilitation teams. It explains that effective decision making requires coordination between experts like doctors, physiotherapists, and coaches. Four key decisions are outlined: deciding the rehabilitation plan, progression, return to training, and return to play. The best approach for each decision is discussed, balancing factors like efficiency, quality of decision, and involvement of stakeholders. Consensus is generally best but can be inefficient, so consultation is also recommended to allow different perspectives while protecting stakeholders. Transparency in the decision making process is important for healthy team dynamics and performance.
TeamSTEPPS 2013 Presentation "Create your own simulations and evaluate them"Melissa Jo Powell
The document discusses a presentation on using simulations and debriefs to evaluate team performance. Some key points:
- The presentation covered developing TeamSTEPPS training scenarios, using simulations and checklists to evaluate behaviors, and identifying the importance of reflection and psychological safety during debriefs.
- A case study was presented on using simulations to address delays in calling rapid response teams at a hospital. Post-training surveys found that simulations helped build confidence and that new communication techniques would be employed.
- Debriefings after simulations were found to promote self-reflection and identification of barriers to improve performance. Teams that debriefed were shown to perform up to 40% better.
This document provides an overview of topics from a training on integrating trauma-informed approaches in behavioral health settings. It discusses the importance of self-care for staff, key principles of trauma-informed care like safety and empowerment. It also covers topics like secondary traumatic stress, burnout, compassion fatigue and assessing these risks using tools like the Professional Quality of Life Scale. Staff are encouraged to complete a self-assessment of their organization's trauma-informed practices and discuss signs of secondary traumatic stress with colleagues.
This document summarizes changes and successes within the surgical services department at MD Anderson Orlando Health over the past year. It discusses (1) the creation of a new chemotherapy department and improvements to outpatient infusion therapy, (2) the integration of the endoscopy department which required cross-training nurses, and (3) the restructuring of surgical areas. It highlights the leadership of the assistant nurse managers in guiding staff through these changes successfully and defining exemplary professional practice.
The 90-day follow up report found that attendees of the 'Exercise for Doctors and Patients' conference reported several statistically significant positive changes in their attitudes and behaviors from before to 90 days after the conference: 1) They reported prescribing exercise and discussing stress management with patients more often; 2) They felt less inhibited in lifestyle discussions due to lack of knowledge or tools; 3) They reported better managing their own stress, diet, and exercise habits; and 4) They reported greater knowledge and confidence in exercise discussions with patients. However, the portion of patients providers discuss lifestyle with and those making progress did not significantly change.
BC Patient Safety Quality Forum (BCPSQC), Story board presented 2013. Highlights from research and projects engaging patients, families, public, physicians and health providers in improved access to health care resources and participating in decision-making. Also on http://www.slideshare.net/paulgallant/"paulgallant my other Slideshare account
Brief interventions and motivational enhancement therapy for alcohol problemskavroom
Brief interventions involve short counseling sessions that provide feedback, advice, and support to motivate individuals to reduce risky drinking behaviors. MET is a client-centered counseling style based on motivational interviewing that aims to resolve ambivalence and increase intrinsic motivation for change. Both approaches are time-limited and focus on negotiating drinking reduction rather than requiring abstinence. Screening tools are used to identify hazardous drinkers who could benefit, with brief structured advice or extended brief counseling sessions depending on severity. Motivational strategies like FRAMES are employed to enhance engagement in the process of behavior change.
This document discusses crisis and crisis intervention. It defines a crisis as an event or situation that exceeds one's coping abilities. The objectives are to understand crisis and intervention, comprehend crisis elements, understand crisis intervention purposes, and know intervention types. Crisis intervention aims to rapidly resolve the immediate crisis, prevent deterioration, and promote growth. The ABC model is described as a directive, nondirective, or collaborative approach depending on the situation. Questioning, summarizing, paraphrasing, and reflecting feelings are important skills in crisis intervention. The intervention process involves identifying the problem, nature of the crisis, perceptions, functioning, and pre-crisis level. Conditions like suicide and substance abuse should be assessed. Educational and reframing statements can help
Readiness for change and the stages of change modelHayleyLoschiavo
The theory of readiness for change is derived from the Transtheoretical Model of behavior change. It conceptualizes an individual's process of recovery across stages of change depending on their expressed readiness. Readiness involves desires, intentions, and commitments to alter a targeted behavior based on personal motivations and goals. It is influenced by beliefs, self-efficacy, locus of control, and other intrapersonal and social factors. Assessing an individual's readiness uses techniques like developing rapport, discussing visions for change, and measuring readiness on scales. Treatment planning aims to encourage and empower individuals to progress through the stages of change by setting SMART goals and preventing relapse. Readiness assessments are useful for conditions like eating disorders where ambivalence is common
This document provides a guide for writing Specific, Measurable, Achievable, Realistic, and Time-bound (SMART) rehabilitation goals and using Goal Attainment Scaling (GAS). It describes a novel 4-part method for writing SMART goals that involves specifying: 1) the target activity or behavior, 2) the needed support, 3) how performance will be quantified, and 4) the time period. This allows goals to be measurable and facilitates using GAS by defining multiple levels of achievement. The guide explains how to use this goal-writing method as part of the GAS process to efficiently set personalized yet standardized rehabilitation goals.
Here is a draft essay applying Peplau's nursing theory to the implementation of electronic health records:
Introduction:
Hildegard Peplau developed the interpersonal relations theory, one of the early nursing theories focused on the nurse-patient relationship. Peplau's theory outlines four phases of the nurse-patient relationship: orientation, identification, exploitation, and resolution. This theory provides a useful framework for examining how nurses can support patients through the transition to electronic health records (EHRs).
Orientation Phase:
When EHRs are first implemented, both nurses and patients will be in the orientation phase. Nurses will need training on the new system while patients may feel confused or anxious about the changes in documentation. It
Parallel Session 2.3.1 What's Your Problem? Lessons on How to Solve National ...NHSScotlandEvent
Diane Murray and Angela Cunningham are the assistant director of clinical improvement and head of midwifery and children's services, respectively. The document discusses creating a culture of safety in healthcare organizations. It emphasizes that leadership must live the values of safety that are espoused, and both management and staff must be committed to rules and completing tasks safely. A culture of safety is built on just learning from mistakes rather than blame, and on proactive and systematic safety practices rather than reactive approaches after accidents.
Amputation is the removal of a limb or part of a limb by a surgical procedure in order to save the life of a person. Amputation is a triple threat. It involves loss of function, loss of sensation, and loss of body image.
The document discusses guidance and counseling provided to 5 employees. It describes various techniques used in the counseling process, including observation, autobiographical sketches, anecdotal records, case studies, cumulative records, and questionnaires. For each employee, the document outlines the specific technique used, how it was implemented, and what information it provided about the employee to help with counseling. The overall purpose of the counseling and guidance was to address work-related issues like lack of promotion and cultural biases, in order to lessen conflicts and create a more sustainable work culture.
A Journey Towards Physical Fitness and Awareness: Applying the TTM to Modify...Elisah Mugwagwa
This document describes one woman's personal journey to improve her physical fitness and wellness through applying the Transtheoretical Model of behavior change to exercise. It introduces the Transtheoretical Model, which describes stages of behavior change, and explains how the woman used it to structure her exercise goals and track her progress over 7 weeks. Through self-monitoring and goal setting based on the model's components, she was able to gradually increase her exercise time and frequency each week from an initial 3 days per week to exercising daily by the 7th week. The document concludes by noting that while the Transtheoretical Model helped structure her exercise program, maintaining well-being requires more than just exercise.
This article discusses integrating mindfulness into the workplace to reduce stress. It begins by providing context on the mindfulness-based stress reduction (MBSR) program and how it has helped over 8,000 people. It then outlines 21 strategies for reducing stress during the workday through mindfulness practices like conscious breathing. A story is shared about a physician who used green dots as reminders to take a mindful breath and relax his shoulders 100 times in a day, which helped transform his experience of stress at work. The article advocates for using everyday cues in the workplace to remind oneself to be mindful.
The document discusses factors that influence self-care behaviors in heart failure patients. It identifies that motivation, knowledge, and barriers like fatigue can impact self-care. Nurse responsibilities include removing barriers and improving patient education. Tools for improving patient knowledge include telephone education, web-based learning, and video education. The document also outlines a plan-do-study-act model for testing behavior changes and improving patient motivation.
The document describes the Stress Management Questionnaire (SMQ) and Stressmastery Guide developed by Dr. James Petersen. The SMQ is an 87-item assessment that measures stress levels across 11 scales. It has been taken by over 600,000 individuals worldwide. After completing the SMQ, individuals receive the Stressmastery Guide, a 41-page workbook that provides suggestions for reducing stress based on their personal results. The SMQ and Guide can be used together in stress management programs, seminars, and for individual self-help.
A Nursing Leadership Guide: Communication, Teamwork, Mutual Support, Conflict...Ahmad Amirdash
This document provides an overview of a presentation on nursing leadership and effective communication. The presentation objectives are to help understand the importance of effective communication, identify barriers to communication, and apply tools to improve teamwork, communication, conflict resolution, and patient safety. Effective communication involves being complete, clear, brief and timely. Barriers to team effectiveness include team composition, working conditions, and resources. Positive outcomes of effective teamwork include reduced length of stay, higher quality care, better patient outcomes, and improved staff satisfaction. Strategies for effective communication, teamwork and conflict resolution include advocacy and assertion, the two-challenge rule, DESC script, CUS, feedback, task assistance, I'm Safe, collaboration, handoffs, situation monitoring
The document discusses decision making in sports rehabilitation teams. It explains that effective decision making requires coordination between experts like doctors, physiotherapists, and coaches. Four key decisions are outlined: deciding the rehabilitation plan, progression, return to training, and return to play. The best approach for each decision is discussed, balancing factors like efficiency, quality of decision, and involvement of stakeholders. Consensus is generally best but can be inefficient, so consultation is also recommended to allow different perspectives while protecting stakeholders. Transparency in the decision making process is important for healthy team dynamics and performance.
TeamSTEPPS 2013 Presentation "Create your own simulations and evaluate them"Melissa Jo Powell
The document discusses a presentation on using simulations and debriefs to evaluate team performance. Some key points:
- The presentation covered developing TeamSTEPPS training scenarios, using simulations and checklists to evaluate behaviors, and identifying the importance of reflection and psychological safety during debriefs.
- A case study was presented on using simulations to address delays in calling rapid response teams at a hospital. Post-training surveys found that simulations helped build confidence and that new communication techniques would be employed.
- Debriefings after simulations were found to promote self-reflection and identification of barriers to improve performance. Teams that debriefed were shown to perform up to 40% better.
This document provides an overview of topics from a training on integrating trauma-informed approaches in behavioral health settings. It discusses the importance of self-care for staff, key principles of trauma-informed care like safety and empowerment. It also covers topics like secondary traumatic stress, burnout, compassion fatigue and assessing these risks using tools like the Professional Quality of Life Scale. Staff are encouraged to complete a self-assessment of their organization's trauma-informed practices and discuss signs of secondary traumatic stress with colleagues.
This document summarizes changes and successes within the surgical services department at MD Anderson Orlando Health over the past year. It discusses (1) the creation of a new chemotherapy department and improvements to outpatient infusion therapy, (2) the integration of the endoscopy department which required cross-training nurses, and (3) the restructuring of surgical areas. It highlights the leadership of the assistant nurse managers in guiding staff through these changes successfully and defining exemplary professional practice.
The 90-day follow up report found that attendees of the 'Exercise for Doctors and Patients' conference reported several statistically significant positive changes in their attitudes and behaviors from before to 90 days after the conference: 1) They reported prescribing exercise and discussing stress management with patients more often; 2) They felt less inhibited in lifestyle discussions due to lack of knowledge or tools; 3) They reported better managing their own stress, diet, and exercise habits; and 4) They reported greater knowledge and confidence in exercise discussions with patients. However, the portion of patients providers discuss lifestyle with and those making progress did not significantly change.
BC Patient Safety Quality Forum (BCPSQC), Story board presented 2013. Highlights from research and projects engaging patients, families, public, physicians and health providers in improved access to health care resources and participating in decision-making. Also on http://www.slideshare.net/paulgallant/"paulgallant my other Slideshare account
Brief interventions and motivational enhancement therapy for alcohol problemskavroom
Brief interventions involve short counseling sessions that provide feedback, advice, and support to motivate individuals to reduce risky drinking behaviors. MET is a client-centered counseling style based on motivational interviewing that aims to resolve ambivalence and increase intrinsic motivation for change. Both approaches are time-limited and focus on negotiating drinking reduction rather than requiring abstinence. Screening tools are used to identify hazardous drinkers who could benefit, with brief structured advice or extended brief counseling sessions depending on severity. Motivational strategies like FRAMES are employed to enhance engagement in the process of behavior change.
This document discusses crisis and crisis intervention. It defines a crisis as an event or situation that exceeds one's coping abilities. The objectives are to understand crisis and intervention, comprehend crisis elements, understand crisis intervention purposes, and know intervention types. Crisis intervention aims to rapidly resolve the immediate crisis, prevent deterioration, and promote growth. The ABC model is described as a directive, nondirective, or collaborative approach depending on the situation. Questioning, summarizing, paraphrasing, and reflecting feelings are important skills in crisis intervention. The intervention process involves identifying the problem, nature of the crisis, perceptions, functioning, and pre-crisis level. Conditions like suicide and substance abuse should be assessed. Educational and reframing statements can help
Readiness for change and the stages of change modelHayleyLoschiavo
The theory of readiness for change is derived from the Transtheoretical Model of behavior change. It conceptualizes an individual's process of recovery across stages of change depending on their expressed readiness. Readiness involves desires, intentions, and commitments to alter a targeted behavior based on personal motivations and goals. It is influenced by beliefs, self-efficacy, locus of control, and other intrapersonal and social factors. Assessing an individual's readiness uses techniques like developing rapport, discussing visions for change, and measuring readiness on scales. Treatment planning aims to encourage and empower individuals to progress through the stages of change by setting SMART goals and preventing relapse. Readiness assessments are useful for conditions like eating disorders where ambivalence is common
This document provides a guide for writing Specific, Measurable, Achievable, Realistic, and Time-bound (SMART) rehabilitation goals and using Goal Attainment Scaling (GAS). It describes a novel 4-part method for writing SMART goals that involves specifying: 1) the target activity or behavior, 2) the needed support, 3) how performance will be quantified, and 4) the time period. This allows goals to be measurable and facilitates using GAS by defining multiple levels of achievement. The guide explains how to use this goal-writing method as part of the GAS process to efficiently set personalized yet standardized rehabilitation goals.
Here is a draft essay applying Peplau's nursing theory to the implementation of electronic health records:
Introduction:
Hildegard Peplau developed the interpersonal relations theory, one of the early nursing theories focused on the nurse-patient relationship. Peplau's theory outlines four phases of the nurse-patient relationship: orientation, identification, exploitation, and resolution. This theory provides a useful framework for examining how nurses can support patients through the transition to electronic health records (EHRs).
Orientation Phase:
When EHRs are first implemented, both nurses and patients will be in the orientation phase. Nurses will need training on the new system while patients may feel confused or anxious about the changes in documentation. It
Parallel Session 2.3.1 What's Your Problem? Lessons on How to Solve National ...NHSScotlandEvent
Diane Murray and Angela Cunningham are the assistant director of clinical improvement and head of midwifery and children's services, respectively. The document discusses creating a culture of safety in healthcare organizations. It emphasizes that leadership must live the values of safety that are espoused, and both management and staff must be committed to rules and completing tasks safely. A culture of safety is built on just learning from mistakes rather than blame, and on proactive and systematic safety practices rather than reactive approaches after accidents.
This document discusses the importance and benefits of debriefing after cardiac arrest events. It notes that debriefing improves CPR performance and results in higher rates of return of spontaneous circulation. Debriefing allows rescuers to reflect on their performance, identify areas for improvement, and learn from real-life events. When used as part of an organized resuscitation response system or as part of advanced life support courses, debriefing has been shown to improve adherence to guidelines and result in better performance during subsequent simulated scenarios. The document advocates for incorporating structured and supported debriefing into the resuscitation process to help clinicians evaluate what happened, how they responded, and how they can enhance outcomes going forward.
This document discusses applying lessons from evidence-based medicine to leadership development. It proposes moving leadership development to a more "evidence-based" approach where the effectiveness of programs is measured by their impact on business results, not just participant satisfaction or learning. The document outlines a four-step process for organizations to directly link leadership development activities to key business strategies and measurable outcomes. Case studies are provided that measure the impact of leadership behaviors on employee commitment and link development programs to improving those high-impact behaviors.
This document provides an overview and agenda for a training on screening and assessment of clients with co-occurring disorders. The training will be delivered in 5 modules over several sessions and aim to teach clinicians how to conduct a thorough 12-step screening and assessment process using the GAIN-SS tool. The training facilitator emphasizes the importance of engaging participants as adult learners and addressing any resistance to change. Resource materials are included to support the training content.
This document discusses the importance of evaluating a clinical microsystem before implementing quality improvement changes. It defines a microsystem as a small team that provides care to a discrete patient population. Evaluating the microsystem using the "5 P's" - purpose, patients, professionals, processes, and patterns - provides an understanding of the current state. This understanding is necessary to develop effective improvements and avoid unintended consequences.
This document discusses the definition of nursing. It examines definitions from nursing theorists like Henderson, who defined nursing as caring for individuals to help them attain health and independence. The Royal College of Nursing defined it as using clinical judgment to provide necessary care for optimal life throughout one's lifetime. Nursing aims to promote health, prevent illness, and care for those who are sick, disabled or dying. It also discusses the evolving roles and functions of nurses throughout history.
By Dr Dave Murray, Consultant Anaesthetist of James Cook University Hospital for the 8th Smart Health Community of Practice (CoP) Forum: Human Factors in the Digitalisation of Healthcare
Article by Dr Mary Haynes about her agency's journey to a recovery orientation via CDOI and PCOMS published in the SAMHSA Recovery to Practice Newsletter.
University of Utah Health Improving Wellness: 40 Champions, 20 Projects, 12 M...University of Utah
On December 14, 2017, the Wellness & Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library will presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which were focused on personal resilience, burden reduction, and team work. The poster session demonstrated the work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
University of Utah Health: Wellness Champion Poster Session 2017University of Utah
Improving Wellness: 40 Champions, 20 Projects and 12-months of Progress: The Wellness and Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which are focused on personal resilience, burden reduction, and team work. The poster session demonstrates work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
Computerized coaching can be an effective way to motivate salespeople when traditional face-to-face coaching has limitations. A cognitive behavioral coaching program delivered online guides salespeople through individualized sessions to change unhelpful thinking patterns and develop behaviors that improve motivation and performance. A trial of the program at a UK insurance company found a 20% increase in salespeople meeting targets, 27% reduction in stress, and resignations reduced by three times. The program identifies and challenges common patterns of unhelpful thinking to help salespeople stay positive in challenging economic times.
This document outlines a 7-step process for providing an online stress intervention program to corporate clients. Step 3 involves employees completing a validated questionnaire to assess stress levels. Step 5 provides online psychological strategies and solutions through a program covering topics like self-awareness, challenging beliefs, building resilience, and effective communication. The results of a study on a similar online program indicate it can effectively complement stress management initiatives and improve psychological well-being by increasing self-esteem and reducing stress and absenteeism.
We have helped many organizations apply neuroscience insights to improve performance, motivation, and employee well-being through various training programs. A global charity saw positive results after a 9-month training initiative introduced strategic and behavioral changes to better capitalize on volunteer motivation. A utilities company transformed a typical customer service training by viewing it through the lens of brain science, making the content more engaging. Feedback from program participants consistently reports increased knowledge, ability to apply lessons, and achievement of business objectives.
Robin Rigney, General Manager of Consupaq, emphasizes that successful implementation of World Class Manufacturing (WCM) depends on team commitment rather than the leader. Consupaq began its WCM journey in 2009, achieving a 44% reduction in lead time, 55% reduction in stock turn days, and other improvements. Rigney notes that his leadership style of fully committing to the program and empowering the team to make mistakes was important for Consupaq's success in achieving its objectives. He advises other leaders to maintain discipline, lead by example in their commitment, and celebrate team achievements.
Proposal for an Effective Model for Dismissal SummariesJulie Bentley
The current system for discharge summaries in the cardiology department is inefficient and leads to errors. Under the current system, sole responsibility lies with the Cardiology Services RN, but a dynamic patient case cannot be fully tracked by a single member.
The presentation recommends adopting a shared responsibility model where the entire cardiology team, including physicians, nurses, and nurse practitioners, are all responsible for the discharge summary. This eliminates finger-pointing since all are accountable, and fixes can be made without looking to blame others. It also promotes a more collaborative team approach.
Most therapists want to improve their skills and help more clients. However, research shows that factors like personal therapy, specific treatment approaches, training, or experience do not necessarily correlate with better outcomes. After studying thousands of therapists over 15 years, one key factor was identified - "Healing Involvement", where therapists are fully engaged with clients through empathy, skills, efficacy, and handling difficulties constructively. This state can be achieved through career development improving skills over time, self-care reducing burnout, and connection to purpose and values in their work.
1) Cost cutting is not always the best approach to managing overhead costs and can hamper a practice's ability to provide quality care if taken too far.
2) A better approach is to view overhead as an investment rather than an expense and structure it to maximize physician productivity through well-staffed exam rooms and support personnel.
3) Overhead starts very high in the morning but decreases throughout the day as fixed costs are covered, allowing later patient revenues to generate higher profit margins. Practices should aim to increase late-day revenues.
The Joint Warfare Centre (JWC) began optimizing its organization in 2012 in response to changing NATO training needs. The optimization process involved reorganizing JWC's structure to better deliver exercises. It faced challenges in getting skeptical staff onboard, but eventually reached a tipping point of support. The new trial organization charts key functions like scenario development to increase agility, performance, and collaboration between divisions. It represents the first fundamental review of JWC's mission to align with its role in connecting forces through training. The optimization process taught the importance of continuous refinement and having the right adaptive culture during organizational change.
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Death from Sudden Cardiac Arrest is a Preventable Crime! What is the Role of ...David Hiltz
Law Enforcement is in a strategic position to help reduce the number of victims from cardiac arrest.
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Citizen CPR Foundation Cardiac Arrest Survival Summit 2021: A Call for Presen...David Hiltz
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connections and communities to save more lives.
Effect of Optimized Versus Guidelines‐Based AED Placement on Out‐of‐Hospital ...David Hiltz
Effect of Optimized Versus Guidelines‐Based AED Placement on Out‐of‐Hospital Cardiac Arrest Coverage: An In Silico Trial.
Our special guests are Christopher Sun, a Postdoctoral Fellow at Massachusetts Institute of Technology’s Sloan School of Management and Massachusetts General Hospital and Timothy Chan, Canada Research Chair in Novel Optimization and Analytics at the University of Toronto who will join us to talk about their recently published research.
Study reference:
https://www.ahajournals.org/doi/10.1161/JAHA.120.016701
WHY COMMUNITIES NEED AN ORGANIZED STRATEGY TO IMPROVE CARDIAC ARREST OUTCOMESDavid Hiltz
Looking to promote HEARTSafe in your community? These slides may help!
For annotated slides with notes, contact the Citizen CPR Foundation HEARTSafe Program Director david@code1web.com
Improving Access to Automated External Defibrillators -Free WebinarDavid Hiltz
Improving Access to Automated External Defibrillators
A FREE webinar hosted by Code One Training Solutions and AED Team.
Friday March 27th from 2:00 PM to 3:00 PM EST
Register Here: https://codeone.enrollware.com/enroll?id=3709808
Although many of our public spaces, schools and venues have AEDs, they are not always available.When a person suffers cardiac arrest, there is a one in five chance a potentially life-saving Automated External Defibrillator (AED) is nearby. But up to 30 per cent of the time, the device is locked inside a closed building, according to a study led by U of T Engineering researchers, published in the Journal of the American College of Cardiology. https://www.utoronto.ca/news/life-saving-defibrillators-often-behind-locked-doors-during-hours-says-u-t-study
Learn how AEDs are being made accessible on a 24/7 basis using weatherproof outdoor enclosures.
HEARTSAFE Community Launch- Cardiac Arrest Survival SummitDavid Hiltz
Building communities of heroes and survivors by improving action and response to cardiac arrest through training, preparation and response protocols.
https://citizencpr.org/heartsafe/
Resuscitation is a "team sport"! Plan to attend the Resuscitation Ocer Program with your institutional peers and learn from
the course faculty as well as from other participants through facilitated and interactive exercises. This course is offered as a
pre-conference workshop in conjunction with the Cardiac Arrest Survival Summit, presented by the Citizen CPR
Foundation.
This dynamic 8-hour certificate program is designed to prepare physicians, nurses and allied healthcare professionals to
effectively organize and implement cardiac arrest guidelines, innovations and best practices to improve outcomes from
cardiac arrests that occur in the hospital setting.
Focus areas include:
• Code committee and code team organization
• Process improvement
• Emergency ultrasound
• Targeted temperature management
• Post resuscitation PCI
• ECMO
• High-quality training
• Mock codes
• Comprehensive CQI and more
The Citizen CPR Foundation is proud to present this course as part of the Cardiac Arrest Survival Summit, December 10-13,
2019, and other pre-conference workshops happening the 9th and 10th. Formerly ECCU, the Summit is the largest and most
well-respected conference on cardiac arrest care for CPR and ECC instructors, nurse & hospital educators, researchers, EMS
and PAD program managers, EMS medical directors and survivors.
Learn more and register for the ROP course or for the Summit in its entirety by visiting citizencpr.org/summit. We look
forward to meeting you there.
This document provides guidance on organizing a mass CPR/AED training event. It discusses establishing a task force, holding a preliminary planning meeting, registration, volunteers, fundraising, promotion, logistics, timelines, training content, and making an impact in the community. Key steps include forming committees to oversee registration, volunteers, fundraising, promotion, and logistics. The roles of these committees are outlined along with sample materials like letters, registration cards, and checklists to coordinate the event.
The Journal of Collegiate Emergency Medical Services (JCEMS) and
NCEMSF are proud to host the Academic Poster Session at the
25th Annual Conference.
Abstracts for poster presentations are encouraged from students
and professionals on (1) original research or (2) the development
and evaluation of novel initiatives and programs. Topics include:
• Pre-hospital patient care
• Operations, communications, and equipment
• Training and education
• Administration and agency development
• Career and alumni resources
• Campus public health and safety
Authors of accepted abstracts will present posters at a 1-hour
academic poster session.
All accepted abstracts will be published in JCEMS.
Submission Guidelines
Deadline:
January 15, 2018
For details, please review the Poster
Abstract Submission Guide at:
www.ncemsf.org/conference/2018-conference
Review and Selection
Abstracts will be reviewed and selected
by the JCEMS Editorial Board.
Independent reviewers with subjectmatter
expertise may also review
submissions.
Conference Details
Details available at:
www.ncemsf.org/conference/2018-conference
Improving Bystander CPR, Community Mobilization and Outreach Using Media Infl...David Hiltz
All of you sitting out there have great stories to tell. Stories that will save lives. And news organizations want them.
You just need to figure out how to get the stories out in your communities and better yet, how to get the news organizations to get them out for you. Because the holy grail of any public relations effort, any educational effort, that aims to reach a mass audience through mass media is a staff written story.
And changes in the news industry that are challenging newsrooms across the country are in your favor.
My comments are based on a working knowledge of small, community news organizations, not the big guys, but I believe the same holds true them as well.
It’s no secret that the number of reporters and photographers and editors in traditional newsrooms is shrinking. But news editors still have holes to fill in print editions and they face a constant challenge to keep their websites updated with new information 24/7.
Those challenges are your entryway.
But you won’t gain entry without your own challenges. Those tight staffing situations may make your mission harder at the outset than it might have been 10 or 20 years ago when newsrooms were flush with young reporters looking for their next story.
You’ve got to get a reporter or editor to take the time to listen to you and they’re all wearing several hats taking care of print issues and web site updates and social media posts. So be politely persistent.
David Hiltz was and he ended up getting more than one message into our paper and on our web site. If I may, I suggest you borrow a line from David. After challenging him to tell me why we should be writing about this stuff as a general circulation newspaper and website rather than a medical journal, he had the perfect line.
“If 15-20 people were needlessly dying in house fires in Westerly each year, would that be newsworthy," he asked. "How is cardiac arrest any different?"
Perseverance will be key, but if you get your pitch down right -- make it brief, but compelling – you should be able to convince an assignment editor that you’ve got a story that will get lots of eyeballs on his or her website -- and maybe even convince someone to grab a print copy off the rack.
Local and unique are the keys to good news stories in 2017 when global news is available from any number of news outlets as soon as you grab you smartphone in the morning. And all of you have unique, local stories from your communities. Stories about regular citizens saving lives on the street because they learned how to do CPR or because they learned how to use an AED.
Access Denied! Failures in Automated External Defibrillator DeploymentDavid Hiltz
This presentation will examine current practices in early defibrillation strategies including defibrillation by law enforcement and PAD models. While millions of defibrillators have been placed in public venues, many victims are not defibrillated in a timely fashion.
Why do current practices fall short of expectations?
Early Heart Attack Care Discussion ACC CongressDavid Hiltz
This document discusses the partnership between Early Heart Attack Care (EHAC) programs and Emergency Medical Services (EMS) to improve cardiovascular health in communities. It outlines mandatory and recommended components of community outreach in the areas of community health improvement and community education where EMS can be involved, such as offering joint EHAC and CPR training courses. The future of EMS is envisioned as more integrated with the overall healthcare system to identify and address risks, provide acute care as well as chronic condition management, and improve community health.
The document discusses using exposure therapy techniques in CPR education to address real-life fears that potential rescuers may experience when encountering a victim of sudden cardiac arrest. It proposes exposing CPR course participants to simulations of agonal breathing, seizures and posturing during training, while also providing frequent reassurances about the frightening nature of such situations, in order to desensitize people to the fears and increase their willingness to take action during a medical emergency. The approach aims to break the link between feared situations and panic reactions through controlled exposure and reduce fear without inducing fear.
The document discusses the politics of risk and disasters. It notes that experts in different fields like airplane safety, neuroscience, and disaster response do not often share knowledge and experiences with each other or the general public. As a result, valuable insights into risk and how to prepare for disasters remain siloed within individual specialties rather than being integrated more broadly. The conclusion calls for overcoming these barriers so that people everywhere have access to information that could help them survive disasters, regardless of where they live.
Strive to Revive! Translating Science to Survival The HEARTSafe Community Co...David Hiltz
Often it "takes a village" and indeed the entire community to make a significant difference! Hear how the HEARTSafe Community concept is designed to promote survival from sudden out-of-hospital cardiac arrest by recognizing and stimulating efforts by individual communities to improve their cardiac arrest system of care.
Death From Cardiac Arrest is a Real Crime! Can Law Enforcement Reduce Time ...David Hiltz
This document discusses the potential role of law enforcement in reducing time to CPR and defibrillation for victims of sudden cardiac arrest. It provides an overview of studies showing improved survival rates when law enforcement responds rapidly to medical emergencies and uses AEDs. Successful law enforcement AED programs have certain attributes, such as the ability to respond quickly to emergencies, as outlined in the NCED LEA-D best practices checklist. While evidence supports the law enforcement AED concept, ongoing issues include medical oversight, training, and program coordination.
This document discusses improving cardiac resuscitation systems of care. It describes how some systems achieve survival rates over 50% for cardiac arrests due to ventricular fibrillation through coordinated efforts including bystander CPR, public access defibrillators, EMS response times, and post-resuscitation care. The document outlines key components of model systems including establishing registries to measure performance, improving layperson and EMS involvement in CPR, and decreasing time to access emergency care. It emphasizes that the overall system of care, not individual components, determines survival rates.
Resources for the "Challenging Sudden Death: A Comprehensive Approach for Imp...David Hiltz
This document provides links to various resources for improving outcomes from sudden cardiac arrest, including a 10 step approach for improving survival, AHA guidelines on resuscitation quality improvement, toolkits, and presentations on ideal cardiac arrest systems of care, issues in out-of-hospital resuscitation, the science behind chest compressions, EMS roles, dispatcher-assisted CPR, citizen CPR education, law enforcement defibrillation, and improving access to defibrillators. Videos are also linked to demonstrate community CPR programs and training.
Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when a person's breathing or heartbeat has stopped. It involves chest compressions to manually pump blood through the body and deliver oxygen to vital organs until emergency medical services arrive. The recommended chest compression to ventilation ratio during CPR is 30 compressions to 2 breaths for all ages.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Debriefing and Cardiac Arrest Quality Improvement
1. Debriefing and Cardiac Arrest Quality Improvement
An interview with David Baumrind, EMT-CC
Written by David B. Hiltz, AHA ECC Programs-Public Safety
Recently, David Baumrind of East Hampton, NY and I began talking about various
strategies to improve resuscitation outcomes. As part of those discussions, we
talked about debriefing and how it could be used to help improve the quality of
resuscitation being provided, as well as sharing our perspectives on the subject.
Hiltz: David, could you introduce yourself and tell us a little about your involvement in EMS?
Baumrind: Sure. My name is David Baumrind, and I am an EMT-Critical Care in Eastern Long
Island, NY. I got my start in EMS in 2006 with a volunteer agency in East Hampton. Like
many, I really enjoyed EMS, and in 2009 became an ALS provider.
Over the past couple of years, I have taken it
upon myself to learn as much as possible
about cardiac arrests and the quality of
resuscitation. I was frustrated about our low
survival rates, and thought there must be an
opportunity for us to improve. I learned
about Medic One and their fantastic survival
to discharge rates, and some of the things
they are doing to improve. In my area, as
with so many others, we do the best we can,
but we don’t have any success rates that can
come close to those organizations that are
leading the way. So, in 2011, I’ve made it a
mission for myself and my agency to try to
raise the bar and improve our resuscitation
outcomes. In fact, our organization created
the position of STEMI/Cardiac Arrest
Coordinator, dedicating resources to
improving our patient care in this area. One
of the first and easiest steps to implement
was a structured debriefing with the crew
after each cardiac arrest call.
Hiltz: David, we have had some really great discussions regarding strategies to improve cardiac
arrest survival, eliminating what Dr. Mickey Eisenberg calls “survival envy” and I think we both
agree that this can be a daunting task. What other strategies are you considering in East
Hampton and how/why did debriefing “rise to the top” as a priority?
2. Baumrind: Well Dave, I have to say, looking at places like King County , WA, and Rochester
MN actually gives me great hope. As they will tell you, it’s not magic, or anything that can’t be
accomplished anywhere else. If they are at fifty percent survival to discharge, it seems even if
we got to fifteen percent it would have a huge impact on our community. We don’t have to be
King County, but the message is that it is possible. Having said that, they’ve been at it for
decades, and we are just starting. We also don’t have the same resources available that maybe
some other places do, but we have enough to make progress and that’s what we’re about. As
someone from King County told me in Baltimore at last year’s JEMS conference, it might take a
lot to get to where King County is now, but it won’t take an unreasonable amount of work to
make a measurable jump in survival rates from where we currently are.
Some of the strategies we are implementing in
the near term involve changing our culture.
Raising the awareness of what is possible, how
we are going to try to get there, and what the
implications are to our community. We are
going to utilize more data from our
monitor/defibrillators about how efficiently our
codes are run, we are going to train in teams
using the “pit crew” model that has been well
publicized of late, and of course our priority was
to implement structured and supported
debriefings after each code.
There are a couple of reasons structured and supported debriefings rose to the top as a priority.
First, we could get a huge return with a minimal investment in resources and time. What I
specifically mean by that is that they are easy to implement, with a small investment in time by
both the facilitators and providers. What we are getting back is a huge change in culture, and a
huge amount of hard and anecdotal information to help us get better. It has been nothing short
of a “home run”.
Hiltz: Sound reasoning, David. As you know, Part 16: Education, Implementation, and Teams:
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care state:
“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 learning strategy
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).”
3. They go on to say “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.”
Did you do any additional reading or training to prepare yourself (and others in your agency) to
maximize the effectiveness of your debriefing efforts and strategy?
Baumrind: I found “Resuscitate! How Your Community Can Improve Survival from Sudden
Cardiac Arrest” by Mickey Eisenberg. In this book, Dr. Eisenberg talks about fifty factors
associated with improving care and outcomes for cardiac arrest and describes twenty-five
specific steps associated with improving a community's cardiac arrest survival rate. The book
offers recommendations for both immediate and long-term improvement of EMS services
including actions that can be taken at all levels.
I spent a good deal of time speaking with people from King County to get ideas on how best to
apply some of what they have accomplished to our system. We are spending time with our
Monitor/Defibrillator company to maximize the useful raw data we can get off of our monitors
for use in our debriefings. We have acquired high quality (instrumented) CPR manikins, on
periodic loan, to aid in our CPR and teamwork skills. Additionally, the Structured and Supported
Debriefing course by the American Heart Association has been extremely helpful to us. The
principles of that course were immediately applied to our debriefings.
Hiltz: I recently completed the Structured and Supported Debriefing program myself and like
you, found it to be an efficient means of improving my intuitive debriefing skills. The course has
helped me to conduct a structured and supported debriefing using a directed debriefing
approach. The Structured and Supported Debriefing course covers debriefing methods,
creating a supportive environment, establishing roles and goals of the interaction along with
information and insight on genuine inquiry, active listening/organized communication,
generating accurate records and dealing with obstacles and challenges.
Baumrind: We are at somewhat of a disadvantage in that we don’t have a large number of
cardiac arrests per year and therefore we don’t have the opportunity to gather information and
practice what we are trying to apply very often. That makes it imperative that we get the most
out of debriefing the cardiac arrests that we do run, to drive our resuscitation training and
education. In the immediate term, our goal is to debrief as soon as practicable, no more than
48 hours after the arrest.
WE USE ICE CREAM DIPLOMACY!
When we meet, we do so in a non-threatening
manner, so that the crew knows the purpose is
not to judge performance, but rather to gather
information about that performance to better
ourselves for the next one. It may seem like
semantics, but it really isn’t. The person
running the debriefing is an ALS provider who
did not participate in the actual call, but is
trained in running debriefings.
4. That person essentially acts as a
“facilitator”, to draw out the
information and experiences from
the providers on the call. The
debriefing is essentially learner-
focused, with the content of the
debriefing directed by the crew.
This promotes a safe environment
for sharing of experiences, without
the fear of being judged. This is
not necessarily easy to do, but is
the cornerstone of the structure we
are using, and imperative for the
success of our program.
Essentially, we are trying to identify
what would be the “ideal”
performance for how we run a
cardiac arrest and through
teamwork, training, and education
trying to get our actual
performance as close to our ideal
as possible.
-Baumrind
5. Hiltz: It sounds like your debriefing efforts have been going well. Could you describe your
experience with the Structured and Supported Debriefing program? What do you see as the
essential features and benefits? Additionally, who would you recommend the program to?
Baumrind: Well, we are a work in progress, and I suppose we always will be. The Structured
and Supported Debriefing program gave us a great framework to start with. We have been
using the G-A-S approach, Gather-Analyze-Summarize, with great success.
During the Gather phase of the debriefing, the person running the debriefing facilitates a
group discussion from the crew that ran the arrest. The crew talks about their experiences
during the arrest. They talk about anything from what they found when they arrived on scene,
to which arrest algorithm they entered and why...they share their perceptions of the event, and
any logistical challenges that they may have faced. They address what they thought went well,
and what didn’t. Basically, in this phase the crew is addressing their perceptions and feelings of
the event, and how it went. Also during this time, we collect any raw data from both the
cardiac defibrillator, as well as the AED if one was used prior to EMS arrival.
In the Analyze phase, analysis of the performance is facilitated. We review the raw data and
events and the crew reflects, in their own words, on what could be improved on and why. We
talk about compression fractions, how they could be improved and how to be more efficient in
general with respect to time. We review the “Pit Crew Model”, how it was applied, and how we
can tweak it to better meet our needs. Basically anything that can be identified to help us
improve going forward is addressed here.
In the Summarize phase, we review and identify the “key points” that came out of the
discussion. We talk about how we can use these key points to implement changes going
forward for our agency as a whole. We talk about how we can best structure trainings to
practice what we are trying to do. “Green light” thinking is encouraged, to come up with any
idea that can help us take what we identify during the debriefing and using it to improve.
You see Dave, We may be debriefing a single cardiac arrest, but we are talking
about every cardiac arrest that will follow. It is not about the six or seven providers
in the room, but the community as a whole.
I can tell you that since we started the debriefings, there has been a notable
improvement in efficiency and performance. Our compression fractions have
improved. Our providers are talking about arrests in a different way, not being
satisfied with the status quo of resuscitation. In a very short time, we are seeing
measurable improvement in performance that over time will translate into more
survivors of sudden cardiac arrest in our community. This has created some
momentum for our program, and has motivated us even more.
I would recommend the Structured and Supported Debriefing program to any agency that
wants to improve their resuscitation efforts. To any agency that isn’t afraid to set the bar
higher, to look in the mirror and ask “how can we do better”.
6. HOT LINK TO VIDEO DEMO: http://www.slideshare.net/Hiltz/structured-and-
supported-debriefing-demo
Hiltz: That is terrific, David! It sounds like that in addition to successfully incorporating a
debriefing strategy into your QI plan, you have also observed several unintended (and positive)
consequences. Your comments lead me to believe that you are well on your way in developing
the elusive “culture of excellence”.
Baumrind: I would say that you never know how good you can be until you try! Sudden
Cardiac Arrest is a major issue here and everywhere else, and not only do we want to do the
best job we can, we want to do what is necessary (Brent Myers, MD).
I suppose time will tell how well our efforts translate into increased survival, but we remain
optimistic. We know what’s possible from King County and other places, and we know that
from the time we instituted our Structured and Supported Debriefing program we have started
to see some really positive changes.
It’s not necessarily easy to make changes, but it doesn’t have to be overly difficult either.
Change is an essential facet of the iterative process associated with quality improvement.
Change requires a commitment and a vision. At the end of the day, we want to provide the
very best resuscitation care that we can for our community.
For others that want to improve their resuscitation care, I would say that the Structured and
Supported Debriefing program is a great place to start. We were fortunate to have had some
great help when we got started, and in turn we would be happy to help others. I can be
reached at Sky63@optonline.net. Thank you David!
Hiltz: It has been my distinct pleasure to have met David and to have had so many productive
discussions with him. This one, about debriefing seemed to grow some teeth and I am
privileged to share his perspective and experience.
Debriefing has distinctive merits, appears to be easily implemented by virtually any EMS
agency, and has yielded not only predictable results, but also a variety of unintended
consequences that led to localized adaptation and implementation of strategies to improve
outcomes from sudden cardiac arrest.
Many thanks to David Baumrind and all those who endeavor, on a daily basis, to improve
response, care, systems, and outcomes for cardiac arrest patients. I, along with the American
Heart Association continue to acknowledge and share in the EMS community’s goal of improving
patient outcomes through the development and delivery of the highest quality prehospital care
available.
We are grateful for our interaction and collaboration with EMS agencies and providers across
the globe.
7. How to connect with David Baumrind
David’s email is Sky63@optonline.net.
About David Hiltz
David has over 25 years experience in the healthcare industry with a special interest in
emergency medicine and resuscitation. His current full time occupation is with the
American Heart Association’s Emergency Cardiovascular Care Program-Public Safety
Team. David is a member of the Massachusetts Department of Public Health’s
Emergency Medical Care Advisory Board and current Vice Chair of the Board’s EMS
Education and Public Education and Information and Resource Committees.
David is also well known for his work with the HEARTSafe Community concept and was
recently recognized by JEMS and Physio-Control as an Innovator in EMS. Visit David on
Facebook or email him david.hiltz@heart.org .