Download - Alert 2014-new-mullan2
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: [email protected]
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