Structured debriefing sessions for discussing difficult patient situations Christopher Park, MD Pediatrics Co-Chief Resident Nebraska Medicine Creighton University Children s Hospital of Omaha
Disclosures No disclosures No funding for surveys or debriefing sessions
Why did they start? What are these debriefings? What have we found from these sessions?
Why did we start debriefings? Out of necessity Response to healthy patient who decompensated unexpectedly M&M 6 months after the patient death
What is a debriefing? Opportunities to discuss difficult patient situations Patient deaths Conflicts in goals of care Trauma, especially non-accidental Hot debriefings and standing meetings M&M = Mindfulness in medicine
What should we discuss? As little medical treatment as possible Talk about the care of the patients and their families Talk about our interactions with them as children and not just patients Talk about our interactions with the medical team Talk about our shared experiences in similar situations Talk about how we deal with these things outside of the hospital
Effectiveness of our debriefings Pre-intervention surveys Post-intervention surveys All surveys are anonymous None of the data obtained was statistically significant Small sample size is not sufficient to infer stastical significance Trends are somewhat interesting Used survey to elicit beliefs regarding debriefings as well
How often do you experience a difficult patient situation with a significant impact on you emotionally or professionally? 60% 55% 50% 40% 30% 30% 20% 10% 0% Daily Weekly Monthly Yearly Rarely Never 15% n=20
How often do you get a chance to debrief? Pre survey Every time 0% Most of the time 14% Half of the time 17% Less than half of the time 46% Rarely or never 21% Post survey Every time 0% Most of the time 40% Half of the time 35% Less than half of the time 15% Rarely or never 10%
How often do you have debriefing sessions following difficult patient situations where you feel comfortable sharing your emotions and the impact on you personally or professionally? 50% 45% 40% 35% 40% 35% 46% 30% 25% 20% 15% 10% 14% 17% 15% 21% 10% 5% 0% Every time Most of the occurrences Half of the occurrences Less than half of the occurrences Rarely or never Pre-intervention (n=32) Post-intervention (n=20)
What factors have been difficult in dealing with a difficult patient situation? Knowing patient or family well 80% Not enough aggressive treatment 0% Continued too aggressive treatment 55% Personal inexperience 70% Underestimated patient acuity 40% Fatigue 45% Conflicts in perspectives on medical team 40% Seeing families/patients go through similar experiences to my own As a parent, watching a parent experience grief of a sick or deceased child
Identified coping strategies Discussion with co-residents 100% Discussion with attendings 50% Discussion with administration 30% Exercise 70% TV, movies, music, private time 70% Ignoring/suppressing feelings 35% Food/alcohol 55% Humor 75%
Who should attend? Residents only 0% Residents and attendings, run by residents 74% Residents and attendings, run by attendings 15% Residents, attendings, nursing, case managers, etc. 7%
The positives Keeping an open agenda allows for a more natural structure of a debriefing session A meeting I actually look forward to going to. Very supportive to just speak freely about some of the tougher parts of our job.
I think our resident debriefing meeting fills a need for residents. Due to a number of circumstances; being post call, switching rotations, etc. we often miss the traditional debriefing that occurs in the hospital and this provides a standardized place and time for residents and faculty to get together to debrief. Our meetings are very well attended which further supports how important and beneficial these meetings are. Staff attendance is valuable because they often share words of wisdom to those dealing with difficult patient situations and like residents they are also affected by poor outcomes and benefit from the debriefing process. We also frequently have a palliative care physician attending which is helpful for facilitating conversation and giving patient and family perspective. For residents it provides a safe place to openly express your emotions and I often find other residents are dealing with the same difficulties I am. It is a very supportive group and I always leave the debriefing meeting in a better mood than before it started.
I think our resident debriefing meeting fills a need for residents. Due to a number of circumstances; being post call, switching rotations, etc. we often miss the traditional debriefing that occurs in the hospital and this provides a standardized place and time for residents and faculty to get together to debrief. Our meetings are very well attended which further supports how important and beneficial these meetings are. Staff attendance is valuable because they often share words of wisdom to those dealing with difficult patient situations and like residents they are also affected by poor outcomes and benefit from the debriefing process. We also frequently have a palliative care physician attending which is helpful for facilitating conversation and giving patient and family perspective. For residents it provides a safe place to openly express your emotions and I often find other residents are dealing with the same difficulties I am. It is a very supportive group and I always leave the debriefing meeting in a better mood than before it started.
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Video too large to send
It was clear to me that everyone really cared, not just about the patient being discussed, but also about each other.
Some outcomes are devastating. Sharing feelings, ideas, and caring for each other can make the difference in picking back up again to face the next challenge.