Table 2 Examples of the “Delta’s” discussed during DISCOVER-PHASE debriefings and follow-up actions taken
Situation described in the debriefing | Debriefing facilitator actions | Response from leadership |
|---|---|---|
Junior emergency medicine resident seen as unprepared to lead out-of-hospital assessment and treatment: - Perceived lack of skills in resuscitation and trauma management skills - Unaware or unfamiliar with standard protocols - Reliant on nurse for guidance | Inform for action - Telephone discussion with director of out-of-hospital emergencies to (resident lack of experience) Inform for awareness - Email to medical and nursing leadership | - Education (e-learning) created and distributed to the residents. - Protocol dissemination via email. - System revision (experienced nurse added to prehospital team and additional access for telephone backup). |
Nurses, physicians, and residents noted problems with access to and understanding of current COVID-19 protocols - Information not readily available to clinicians - Updated protocols not applied in clinical setting | Inform for action - Email COVID-19 incident commander requesting information dissemination Inform for awareness - Email hospital leadership | - Implementation of daily briefing huddles at the beginning of each shift to explain the (new) protocols. - Creation of a password protected website that can be consulted remotely. |
Critical patient treated in COVID-19 zone in standard room (not resuscitation room). Inefficient gathering of materials and equipment, unsatisfied team members (“felt chaotic”, “no clear leader outside medical team leader”) | Inform for action Described teamwork processes and learning opportunities - Lack of task allocation - Lack of identification of people and roles Inform for awareness - Call to the ED medical and nursing leaders to report what teams are experiencing | - Managers met with all physician leaders and encouraged them to explicitly plan for and communicate leadership tasks at the huddles at beginning of a shift and during resuscitations. - ED medical lead, with awareness of the problem and plan, met independently with physicians and supported manager’s request. |
Transferring patients from COVID zone to radiology required coordination between ED nursing, radiology, and transport - Long waits for patients needed CT-scan (greater than 30 min) - Different standards applied by different disciplines (monitoring, PPE, hand-off) | Inform for action - Email to ED leadership suggesting review of ED-radiology interface and protocol Inform for awareness - An email detailing the issue was send to the ED medical and nursing leaders | - Meeting occurred between ED and radiology leadership with an agreement for radiology to call the ED at the time the CT scanner is available to avoid COVID patients in the hallway. - Nursing leadership provided education to nurses supporting the use of PPE for transport to avoid possible contamination of staff and patients. |