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Cold Debriefs: a tool for Quality Improvement & Learning Dr E Pitt, Dr R Alcock, SCN G Fotheringham, Dr K Jacques – Emergency Department, Forth Valley Royal Hospital Introduction & Aim Learning, sharing and applying lessons is central to a system dedicated to patient safety and improving quality of care. There are many formats such as Root cause analysis, Morbidity & mortality meetings and Serious adverse event reviews. None of these provide a means for the actual team members involved to review a specific case they cared for in order to create, share and act on learning specific to our setting. We have developed a reproducible and standardised format for running Cold Debriefs following any case in the Emergency Department (ED) that is felt worthy of review by any member of the team. Our objective is to improve patient outcomes and safety using timely feedback and reflection by the team involved. Methods Over 7 years we have run more than 28 Cold debriefs facilitated by Emergency Medicine Consultants & Nurses. Through an iterative process a standardised format has been developed and agreed. The process is followed from the moment a case is nominated by ANY member involved in any case in the Emergency Department. This multispecialty, multidisciplinary pathway continues until the final Learning and Action Points have been collated, shared and acted on with all relevant hospital departments and pre-hospital services. Types of Cases Results The cold debriefs have resulted in multiple technical, non-technical and human factor changes. Examples of these are shown in the photographs. The benefits of cold debriefs have been recognised and adopted elsewhere within our own and neighbouring hospitals. Staff Feedback Although the primary aim is organisational learning and quality improvement, staff feedback also indicates valuable personal learning, reflection and peer support. When surveyed in 2015 80.5% ED staff stated that they wanted cold debriefs as part of the formal ED feedback & support mechanism. Some of our cold debriefs have also been initiated by Non-NHS Emergency responders. These debriefs are now recognised as standard practice by FVRH Emergency Department staff. Next Steps & Limitations Cold Debriefs are time consuming to arrange & write up. It is possible they may trigger adverse psychological response (but we are not aware of any). In future, we would like to train more facilitators, further refine the process of running a debrief, quality assure the completion of Action Points and sharing of Learning Points, share this practice with other departments that are interested in developing their own Cold Debriefs and conduct research on impact on staff well-being. References Kessler D et al. Debriefing in the ED after clinical events: A practical guide. Ann Emerg Med. 2014; 10:1-9 For more information please contact [email protected] Paediatric death or critical illness: 16 SUDI, Asthma, Drowning, Non accidental injury, Major trauma Adult death or critical illness: 5 Fatal Burns, Sepsis, Difficult Airway, Major Trauma, Chemical Decontamination Obstetric: 4 Perimortem C/Section, Major Trauma, Stillbirth Multi-casualty incidents: 3 Road traffic collisions “This was a difficult challenge for me and demonstrated how the Ambulance Service and Accident & Emergency personnel provide the utmost frontline pre-hospital, Accident and Emergency care in challenging environments. The cold debrief offered closure and on reflection highlighted the importance of sharing information pertaining to the incident” Conclusions • ED staff can deliver multidisciplinary/multiagency/multispecialty cold debriefs for the hospital. • Cold debriefs inform improvements on quality of care as well as learning on structures and processes. • Cold debriefs may help staff well-being but this requires further research.
