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A Mixed Methods Needs Assessment for a Debriefing Intervention Following Critical Cases

  • Arshad J. Jiffry
    Correspondence
    Address correspondence to Arshad J Jiffry, MD, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #113, Los Angeles, CA 90027.
    Affiliations
    Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif

    Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
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  • Christine S. Cho
    Affiliations
    Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif

    Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
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  • Anita R. Schmidt
    Affiliations
    Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif
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  • Phung K. Pham
    Affiliations
    Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif
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  • Alan L. Nager
    Affiliations
    Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif

    Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
    Search for articles by this author

      Abstract

      Objective

      The emergency department (ED) is a demanding environment, and critical events have been identified as contributors to stress. Debriefing is a possible intervention for staff, but there is little information regarding formulation and implementation. A needs assessment was conducted to describe the emotions of pediatric ED (PED) staff following critical events and assess opinions regarding debriefing.

      Method

      This mixed methods study used convergent design for triangulation. After critical cases, PED staff members were given the Peritraumatic Distress Inventory (PDI). Additionally, a questionnaire with 2 open-ended questions on debriefing was administered. Themes were extracted from the questionnaire using directed content analysis.

      Results

      A total of 719 responses were collected for 142 critical cases. Physical reactions were often endorsed in the PDI, and these reactions were mirrored in the qualitative data, which included physiological responses such as stress, adrenaline high, anxiety, fatigue, and overwhelm. Helplessness and grief were 2 of the emotional PDI items frequently endorsed, which were reflected in the qualitative strand by themes such as helplessness, sadness, disheartenment, and regret. There was considerable variability between critical cases such that not every critical case elicited a desire for a debrief.

      Conclusions

      PED staff report measurable levels of stress after critical patient cases that warrant follow-up. Formal debriefing immediately after critical patient cases with specific caveats may be valuable for the reduction of stress. Any formal debriefing program will need to balance various goals with attention to the session length, setting, and timing.

      Keywords

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