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

Debriefing in the pediatric emergency department

      What's New

      • Our mixed methods needs assessment found varied reasons for debriefing, including patient case review, closure, and addressing staff welfare. In critical cases that involved CPR, intubation, or death, there was a desire and need for a debrief with clear objectives.

      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 created 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

      Abbreviations:

      ED (Emergency Department), PED (Pediatric Emergency Department), PEM (Pediatric Emergency Medicine), PDI (Peritraumatic Distress Inventory), PTSD (Post-Traumatic Stress Disorder), ESI (Emergency Severity Index), CPR (Cardiopulmonary Resuscitation)
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