WIP 143 - Rapid Debriefing on the Acute Cardiology Floor

Poster Number: WIP 143
Publication Number: WIP 143.2628

Background: The acute cardiology floor cares for many high-acuity patients who have the potential for rapid decompensation, which is a common source of high anxiety among residents. When rapid response team (RRT) events occur however, they are rarely debriefed by the resident and nursing team in a timely manner despite the implementation of a formal multidisciplinary debriefing process in 2014 using the acronym tool DEBRIEF (Day of, Everyone invited, Be brief, Review the case, Improve team communication, Earlier intervention?, and Find a learning point). In a pre-study survey, many residents expressed a gap in RRT debriefing particularly with nursing staff members while citing many challenges, such as coordination and time. The survey showed that on average, only 12% of rapids occurring on the acute cardiology floor were debriefed with nursing staff, suggesting a need for improved implementation of the formal debriefing process.

Objective: This objective of this Qualitive Improvement (QI) study is to explore methods to increase RRT debriefs on the floor from 12% to 36%. The secondary aim is to improve future floor emergencies and alleviate resident anxiety surrounding these acute situations.

Design/Methods: A key driver diagram for this QI project was developed to outline PDSA (plan-do-study-act) cycles focused on resident debrief experiences on the acute cardiology floor. Our cycles have so far included: developing an orientation to the DEBRIEF tool, labeling resident computers with the DEBRIEF tool, and nominating a nursing champion to increase awareness among nursing staff. We have sent out follow-up resident surveys detailing number of rapids and debriefs during their rotation as well as overall comfort during rapids. Further interventions will include formalized senior resident education through chief resident orientations as well as initiatives focused on the fellow and attending levels. We will then create a run chart detailing the number of RRT and code debriefs with each intervention noted throughout the year.