Hello Scott -

Great questions and I have no strong opinion on the recent death of
albuterol but it looks like it is getting a thorough debriefing even as I
type this reply. I have worked with multidisciplinary teams to set up
debriefing programs after resuscitations (usually defined as going into the
code bay and/or intubation/defib/CPR occurs,not necessarily death, although
other trigger criteria have been locally defined) in a few EDs .  We use a
structured debriefing form, everyone involved in code is invited, it occurs
minutes to hours after the event (median time ~30 minutes after end of
event), it is feasibly short (median time 10 minutes, IQR 5-12 minutes), a
plus-delta model of debriefing is used which takes limited/no training for
facilitators, scripted ground rules and documentation are used, and it is
co-facilitated by one of the involved nurses and the physician team leader
(more facilitation by nurses generally leads to better and more thorough
discussion).  Oddly enough, I have found that single coverage places often
debrief at a higher rate (38% vs 25% of resuscitations, P>0.05 for a
significant difference at time of analysis) than multiple provider shift
times, with multiple hypotheses existing for why this might be ("one
captain theory", better situational awareness of how to time the debriefing
with staff, etc.). While debriefing might (or might not, as people are
often in a blur after a code anyway) add to the rest of the ED's LOS/TTP
and other metrics, these resuscitation patients generally make up <1% of
and ED's patients (~0.6 resuscitations per day at one site), so we felt
that taking about 6 minutes per day (10 minute median duration x 0.6 daily
proportion) to get together as a team to aim to improve the quality of care
delivery, teamwork, safety, mental health and education of our department
was a worthwhile investment in exchange for those 6 minutes of extra wait
for the other kids in department.

David Kessler (Columbia), Adam Cheng (U of Calgary), and I have written up
a practical guide to ED debriefing in a peer reviewed journal that should
be epub available very soon and can send the citation out once it's out.
Lauren Staple (CHOP) and Naminder Sandhu (U of Calgary) have also recently
published debriefing surveys looking at frequency, barriers, and other
factors that you might find helpful.

Here are the pubmed links to these articles and we can send out the
practical guide hopefully very soon. If you want me to send these articles
specifically or want to use/adapt any resources that have been developed,
just email me and I'm happy to share.


National Survey of Pediatric Emergency Medicine Fellows on *Debriefing* After
Medical Resuscitations.

Staple LE, O'Connell KJ, *Mullan* PC, Ryan LM, Wratney AT.

Pediatr Emerg Care. 2014 Sep 5. [Epub ahead of print]
PMID: 25198763

Implementation of an in situ qualitative *debriefing* tool for

*Mullan* PC, Wuestner E, Kerr TD, Christopher DP, Patel B.

Resuscitation. 2013 Jul;84(7):946-51. doi:
10.1016/j.resuscitation.2012.12.005. Epub 2012 Dec 21.
PMID: 23266394

Postresuscitation *debriefing* in the pediatric emergency department: a
national needs assessment.

*Sandhu* N, Eppich W, Mikrogianakis A, Grant V, Robinson T, Cheng A;
Canadian Pediatric Simulation Network (CPSN) *Debriefing* Consensus Group.

CJEM. 2014 Sep 1;16(5):383-92.
PMID: 25227647

Paul C. Mullan, MD, MPH
Assistant Professor, George Washington University
Attending Physician, Division of Emergency Medicine
Children's National Medical Center
111 Michigan Ave NW
Washington DC 20010
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On Fri, Oct 31, 2014 at 9:34 AM, Scott Freedman <[log in to unmask]>

> ALL:
> Do any of you have an established policy or approach to conducting a post
> rescusitation debriefing with your staff after a child dies in your ED?  Is
> it formal and expected or recommended/ encouraged yet rarely if ever done?
> If you have an approach you use and find to be successful, would you be
> willing to share what you do, who is involved, and typically for how long
> is the session? I am particularly interested in hearing from those of you
> who are single providers and taking time for a debriefing, though likely
> quite valuable, leaves the rest of your department waiting (longer) to be
> seen.
> Thank you.
> Scott
> --
> Scott H. Freedman, MD, FACEP, FAAP
> Chief, Pediatric Emergency Medicine
> Medical Emergency Professionals
> *MEP:  Making People Better*
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:

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