Clinical Debriefing Characteristics in Australian and New Zealand Paediatric Emergency Departments: A PREDICT Study Revisited

Objective: Clinical debriefing (CD) in emergency medicine improves team performance and patient care outcomes. Its use in Australian and New Zealand paediatric emergency departments (PED) was first described in 2009. We aimed to delineate changes in CD over 15 years and explore the barriers and enablers. Methods: An electronic survey was distributed to members of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network to explore their CD experiences and opinions of CD in PED. Results: Between February and March 2023, 170 PREDICT members were emailed the survey link with 48 surveys returned (return rate 28%). The respondents were senior doctors (33/48 (68.8%)), junior doctors (5/48 (10.4%)) or nurses/nurse practitioners (7/48 (14.6%)). Thirty respondents (63.8%) had more than 15 years of clinical experience, and 23 (47.9%) worked in tertiary paediatric hospitals. In the preceding year, 36/45 (80%) had participated in at least one debrief immediately following an event, and 27/45 (60%) at a scheduled debrief. Sixteen of 40 respondents (40%) used a department-specific debriefing tool. Resuscitation team leaders facilitated most CDs (27/40 (67.5%)) with 12 clinicians having prior facilitator training. Education, quality and service improvement, and psychological debriefing were reported as important objectives. Leadership and psychological safety were enablers, whereas departmental pressures and lack of training were major barriers. Conclusion: We demonstrated that CD implementation in paediatric EDs has increased over 15 years while individual clinician participation was infrequent. Key enablers were leadership, psychological safety, and promoting a debriefing culture. Facilitation training opportunities were identified as a need.