O2072: Quality Improvement Initiative to Increase the Rate of Code Blue Debriefing in Level IV Nicus

Purpose/Objectives:

Background: Code Blue events are recognized as critical events where the medical team is working under extreme pressure and needs to be highly coordinated to achieve optimal performance and outcomes. Team debriefing after code events has shown to improve team performance and is a crucial aspect of code review.
Specific

Aim: To increase the rate of immediate debriefing after code blue events in level IV NICUs from each center’s baseline to 80% within 2 years.

Design/Methods:

Design/Methods: Thirteen level IV NICUs who are part of the Children Hospital’s Neonatal Consortium participated in this project. The number of beds in each unit varied from 39-120. Each participating NICU had a dedicated team composed of at least one NICU attending and one NICU nurse (bedside nurse, charge nurse and or nurse manager). The IHI model for improvement with PDSA methodology was followed. The primary outcome measure was the number of codes that were debriefed each month.
A process map and key drivers diagram were established, and several interventions were implemented including the creation of a standardized debrief form (PDSA #1), team training (PDSA#2), electronic forms, 360 data overviews (PDSA#3), and monthly collaborative meetings. In a Redcap® database we tracked the number of total codes, the number of debriefs, and barriers to not performing debriefs.

Results:

Results: The collaborative achieved an improvement in events debriefed from 50% to 76.8% between 2018 and December 2022 (Figure 1). Two center line shifts were observed soon after the first intervention and later on, after the third one. Some centers demonstrated more improvement than others, with a total of 6 out of 13 centers improving between 17% to 67% from their own baseline. Funnel plots show that three centers were outside control limits with one center not debriefing enough, and the other two debriefing above 95% (Figure 2). The primary barriers identified for noncompliance with debriefing were lack of time to perform the debrief and difficulty debriefing codes that occurred at the end of the shift. Number of codes per month did not impact rates of debriefs performed.

Conclusion/Discussion: Conclusion(s): Participants benefit significantly from the possibility of sharing barriers as well as tools and tactics to overcome them. Although the 80% goal was not achieved, almost all centers were able to maintain the improvements and reduce variability, showing the benefits of participating in a multicenter collaborative.