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

• 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%)

International Network for Simulation-based Pediatric Innovation, Research and Education

Background

1Sandhu, 2013. 2Ireland, 2008. 3Hayes, 2007. 4Sandhu, 2013.

Can we get frontline providers to debrief in a consistent, timely, and effective manner without any training in debriefing?

• 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

PICO Question

• 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

International Network for Simulation-based Pediatric Innovation, Research and Education

Design

1Mullan, 2013

• 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

Intervention & Randomization

• 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…

International Network for Simulation-based Pediatric Innovation, Research and Education

Design: Outcomes

1Donoghue, 2011, 2Cooper, 2010, 3LeFlore, 4Rudolph, 2007

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

Contact Information