Abstract
Neonatal intensive care units (NICUs) often experience acute clinical events. Post-event team debriefs can reinforce success, identify areas for improvement, and improve healthcare providers’ (HCP) psychological coping. However, barriers exist to successful debriefs, and poor debriefs can increase HCP stress.
To implement and evaluate structured post-event clinical debriefs for NICUs within a regional neonatal program.
We assembled a multi-disciplinary implementation team, adapted an existing tool (INFO Clinical Debriefing Tool), and identified champions for each site (2 level 2 NICUs, 1 level 3 perinatal NICU, and 1 level 4 surgical NICU). A REDCap database, debrief triggers, feedback process for recommendations to quality improvement leads and frontline HCPs were developed. We chose charge nurses as facilitators as they were consistently present but were not team leads. Facilitators were trained in 2-hour Zoom sessions with a didactic presentation followed by simulated debriefing practice. Debriefs were then started and tracked. A post-implementation survey was conducted at 6 months.
Eighty-one HCPs responded to the pre survey, identifying time stress and skill / availability of facilitators as main barriers. Most nurses (75%) were comfortable participating in debriefs; this approached 100% in other disciplines. However, there were negative experiences reported. (Table 1) Ninety-five debriefs were conducted in 6 months; 50% were delivery room resuscitations, 14% were in-unit events. Median 7 (IQR 5-8) HCPs attended; 85% had 3 or more disciplines attending. Most (81%) were led by trained facilitators, with 80% led by nurses or respiratory therapists. Debriefs took a median 12 minutes (IQR 8-17), and generated recommendations for improvements to equipment, team communication, and processes. Two sites had more success with uptake, facilitated by consistent presence of champions. Barriers to implementation included: availability of trained facilitators, time constraints, competing unit priorities. The post survey (85 responses) showed a positive view of INFO debriefs. Most respondents (88%) had participated in at least 1 debrief; of these 76% report positive / very positive experience, 76% thought team members always had the chance to speak up, and 78% felt the INFO process provided an effective mechanism for communicating concerns. Participants still listed time pressure as the main barrier.(Table 2)
Nurse-led, structured post-event clinical debriefs can be implemented in NICUs and are positively viewed by participants. NICUs experience implementation barriers that need to be considered.
