Table 2 Examples of identified issues from debriefings that were subsequently addressed to improve care processes
Situation described in debrief form | Relevant quote(s) | Clinical environment | Response from clinical team and/or leadership |
|---|---|---|---|
The attending physician found it useful to have assistance in donning full PPE during a crisis situation | “Dress the code leader!” | Cardiac ICU | The team suggested having additional team tasks for PPE assistance and a role dedicated to helping the team leader don PPE. |
The inpatient team on the COVID floor instituted a dedicated PPE doffing area and a doffing monitor team role | “EC RN unaware of the Doffing area on 15th floor ‘Covid cohort’” | General pediatric inpatient floor | Information was provided to other hospital teams regarding PPE best practices on the COVID floor as other teams were unaware of this practice. |
Concerns raised by staff members about access and quality of available personal protective equipment | “RN has to make multiple calls to supply chain department to obtain N95 masks. Continued concern re: the ill fit of the blue plastic gown (mainly neckline exposure).” | Obstetrics area of the hospital (antepartum floor and/or labor and delivery floor) | The team decided to have daily huddles to review the current PPE protocol and availability. Laminated signs for reviewing PPE donning and doffing were posted in clinical areas. |
During resuscitation (at a community EC site) of a patient felt to be an extracorporeal membrane oxygenation (ECMO) candidate, concerns were raised regarding which clinical team was primary, and where the patient under investigation should be cannulated | “Clarity of ‘who owns the patient, EC or PICU?’”; “Would like to have clarity about preferences of ECMO team to cannulate in EC vs PICU?” | Emergency center | Workflow regarding the preferred location for cannulation during the pandemic, and the workflow for ECMO cannulation at community sites, was reviewed with key leadership staff members. |
Difficult to include members of multiple teams in the same-day debriefing of a complex event | “Debrief conducted in person and via multiple phone calls to include multiple nursing staff members from both WAC and WSU.” | Obstetrics area of the hospital | The debriefing QI team expressed appreciation of attempts to be inclusive. The debriefing workgroup recommended the usage of DISCOVER-TooL more than once per event if geographically separate teams could not simultaneously debrief. |