Development of a Novel Clinical Debriefing Tool to Promote Team Learning and Process Improvement During the Covid-19 Pandemic (1090-003560) (Research Abstract Professor Rounds: Group 4)
Start time: Thursday, January 28, 2021, 1:00 PM End time: Thursday, January 28, 2021, 2:00 PM Session Type: Research Abstracts (Completed Studies)
Content Category:
Researcher
Hypothesis:
The COVID-19 pandemic has created many challenges for teams across a variety of healthcare environments. Shifting clinical guidelines and safety protocols have provided opportunities for rapid-cycle process change and the evolution of new communication strategies. Opportunities for discovery during a crisis create an urgent need to gather and disseminate information to improve patient care and keep providers safe. To help healthcare workers and their leaders seek information about the proper use of personal protective equipment (PPE), teamwork, medical management and crisis resource management for COVID-19 events, we created Debriefing in Suspected COVid-19 to Encourage Reflection & Team Learning (DISCOVER-TooL). This novel tool allows teams to reflect on high-risk events, and identify safety threats and potential solutions that can be shared with leadership and with other teams across the hospital or health system.
Methods:
DISCOVER-TooL was adapted from the prior DISCERN tool, and was designed to address safety threats related to COVID-19. Both tools assist teams during self-guided debriefing after a clinical event. DISCOVER-TooL provides advice for briefing the team about of the tool, how to have a safe discussion on what went well in the care of the patient, and to identify opportunities for improvement. Specific categories to guide the discussion include logistics (e.g. patient flow, use of PPE), communication team roles and responsibilities (leadership, followership, role clarity), and medical management (e.g. treatment of respiratory distress or shock). The prompts on the DISCOVER-TooL direct teams to identify potential solutions for challenges they have encountered during patient care. An intraprofessional team was assembled to review each form that was submitted, and to categorize and follow up on safety concerns and suggestions for process improvement.
Results:
The DISCOVER-TooL became available for clinical event debriefing on March 31, 2020. Since that time, 27 debrief forms have been submitted from 9 service areas across the Texas Children’s Hospital system. Based on the data collected, themes were identified and categorized. These included the role of SARS-CoV-2 testing and timing of results; changes in resuscitation team roles due to COVID-19 infection concerns, and limiting staff in the patient room; availability and correct use of PPE; communication challenges due to PPE and having fewer team members in the room; unique considerations for specialized support such as ECMO; and issues related to end-of-life care for a suspected or confirmed case of COVID-19.
Conclusions:
Structured event debriefings using communication enhancement methods such as DISCOVER-TooL and enacting principles of psychological safety are becoming crucial to organizational learning in healthcare environments where teams are subject to rapidly changing and evolving care processes because of COVID-19 and other emerging threats. DISCOVER-TooL can be adapted to varying healthcare contexts, and provides an avenue for information sharing between disciplines and across a spectrum of clinical settings in order to enhance teamwork and improve patient safety.