Table 2 HIT debriefing for implementation using the Consolidated Framework for Implementation Research (CFIR) Framework
From: A novel in situ simulation framework for introduction of a new technology: the 3-Act-3-Debrief model
Goal | Debriefing outline | CFIR domain [construct] | |
|---|---|---|---|
Act One | Introduce HIT in the context of usual workflow | Ensure shared mental model of septic patient | Outer setting [Patient needs] |
For patients at risk for deterioration, telehealth can help team observe the patient using the cart. What is the reality of the workflow at this point? | Inner setting [Structural Characteristics, Implementation Climate] | ||
Explore roles—who would set up the cart? | Intervention [Complexity] | ||
Have participants demonstrate physical maneuvers of cart | Intervention [Complexity]Individuals [Knowledge and Beliefs] | ||
Telehealth RN (in person) demonstrates activating cart—introduces responding eICU nurse | Intervention [Complexity]Inner setting [Networks and Communications] | ||
Learners demonstrate activating cart | Intervention [Complexity]Individuals [Self-Efficacy] | ||
Learners interact with telehealth nurse via cart | Intervention [Complexity] | ||
Act Two | Identify anticipated barriers to HIT use | Ensure shared mental model of severe sepsis | Outer Setting [Patient Needs] |
Explore ED context for using telehealth cart | Inner Setting [Implementation Climate] Individuals [Knowledge and Beliefs] | ||
Explore any prior experience with telemedicine HIT | Intervention [Complexity] Individuals [Knowledge and Beliefs] | ||
When would this be helpful? | Inner Setting [Implementation Climate] Individuals [Knowledge and Beliefs] Intervention [Relative Advantage] | ||
What would make it difficult? | Intervention [Complexity] | ||
Act Three | Explore relevance, communication strategies and clinical pearls | Ensure shared mental model of septic shock | Outer Setting [Patient Needs] |
Telehealth interactions: telephone vs video monitoring | Intervention [Complexity] | ||
Point-of-contact? (MD vs RN) | Inner Setting [Networks and Communications] Intervention [Relative Advantage] | ||
Communication strategies—in front of patient and/or families? | Inner Setting [Culture] Individual [Knowledge and Beliefs] | ||
Conflicting views—how to address (TeamSTEPPS tools) | Inner Setting [Culture]Individual [Knowledge and Beliefs] | ||
The Sepsis Hospital Concept (eICU capabilities and limits) | Intervention [Relative Advantage] | ||
Wrap up: balancing barriers vs benefits | Intervention [Relative Advantage, Complexity] Process [Reflect and Evaluate] |