P3D185: Pilot Project on Clinical Event Debriefing

Purpose/Objectives: How may the American Academy of Pediatrics WHiCED Taskforce assist with CED program development at a variety of sites?
• Pilot a CED program at institutions with different experiences conducting CEDs.
• Identify the feasibility, facilitators, and challenges of implementing CEDs at pilot sites for future expansion as a national program.

Design/Methods: Members of the WHiCED Taskforce with expertise in CED developed and iteratively revised a CED program that pediatricians and pediatric subspecialists may use to satisfy the American Board of Pediatrics requirement to participate in a maintenance of certification (MOC Part 4) quality improvement activity. Additionally, some pilot sites included others including trainees, advanced practice providers, and administrators
WHiCED pilot program structured as a Plan-Do-Study-Act cycle from November 2022 to January 2023:
⎻ Completed demographic survey, completed training on CED, conducted CEDs, and tracked data.
⎻ Discussed process, outcome, and balancing measures in local team meetings.
⎻ Participated in a post project forum to identify feasibility, facilitators, and challenges of implementing CEDs.
• Feb 2023 - present:
• The WHiCED Taskforce analyzed the pilot data:
⎻ Used descriptive statistics for quantitative data such as demographic data, the percentage of clinical events debriefed, Likert scale ratings of balancing measures.
⎻ Performed thematic analysis of qualitative focus group data.

Results: Four institutions participated in the pilot project; 2 had previous experience with CED and 2 did not. An end of pilot data review meeting was conducted and sites reviewed the CED data collected during the pilot using a data aggregation site.
Demographics:
• 3 sites targeted neonatal resuscitations, 1 included rapid response team activations
• Of 59 respondents 57% were physicians, 15% trainees, 11% nurses, 9% advanced practice providers, and 6% administrators
• 58% had participated in a CED during the past year
Impact & findings
• 23 respondents provided free text comments at the end of the pilot study and were categorized: none/blank, appreciation, process, or training:
• 30% of respondents had none, 13% provided appreciation, 13% had comments regarding training specifically that videos were too long.
• 10 (43.5%) respondents provided process comments mainly regarding length of CED form and number of surveys

Conclusion/Discussion: Development of a national project on CED using a MOC Part 4 framework was feasible and well-received by participants. Sites expressed challenges in outcome, process, and balancing measures, which highlight areas where the AAP may help support institutions with a wide range of CED skills to establish local CED programs. Implementation of a CED program can be a valuable quality improvement tool to improve patient care, teamwork, and transparency in patient safety efforts. Adoption of the WHiCED program at additional sites would provide additional feedback on local site needs, including resources and mentorship for successful implementation.