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Debreifing difficult calls

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You have a huge opportunity to learn from critical calls during your turn-around time at the hospital.

After a critical call, while still at the hospital, take 5 minutes to debrief the call and review any lessons learned. This might include cardiac arrest, critical trauma, severe illness, and any call that requires lots of work and critical thinking.

In my experience, most EMS systems offer the ability to take a third rider into the hospital with the ambulance to assist with care of a critical patient.  Typically this will be a firefighter or two from the fire crew you ran the call with.  This results in everyone with whom you ran the call being at the hospital afterward (the fire engine often follows the ambulance to the hospital to pick up their missing crew member)  This means you have a great opportunity to sit down with everyone who ran the call for a few minutes and go over it.

We can learn things from any call.  Critical patients offer not only the best chance to make errors (I’ve made plenty), but also the best chances to learn from them.  Research has shown [sorry, no link] that the best time to review and retain information is one to two days after first introduction of new information.  Typically, if I review these calls at all with anyone besides my partner, it is in one of two settings (outside the call to my training guy with a stream of questions): M&M review or a call into a CQI meeting.  These trainings usually occur 1-2 months after the call: far too long to retain anything important.

So when it is possible, take an extra 5 minutes at the hospital to go over things with everyone involved.  Get permission from your supervisor or from dispatch if necessary.  Everyone will have ideas about what went wrong and right.  Some will have misconceptions about what happened that can be cleared up right then – offering understanding all around and maybe the opportunity to stop a call to your quality manager.  Everyone will have a chance to learn more about that patient and their condition.

It can be difficult to create an environment in these situations where everyone feels comfortable speaking frankly.  I’ll offer some guidelines gleaned from my organizations M&M review own guidelines(themselves taken from the Massachusetts Medical Society and an article from the Journal of Academic Internal Medicine).  All are aimed at creating a comfortable environment.

  1. Make sure that everyone understands that all questions will be respected.
  2. Limit who can participate only to those who were there.  This Any other ambulance crews or hospital staff who are interested in participating should be asked to leave.
  3. Be sure that everyone is comfortable having this discussion.
  4. Most M&M reviews also involve the understanding by participants that nothing leaves the meeting.  Since this is not an official, sanctioned type of meeting involving medical directors and other higher-ups, I really don’t think this is advisable here.  Any significant clinical issues should be brought to the attention of the appropriate people immediately.

Also, if you are the one organizing the discussion, you have the role as moderator.  In addition to creating a comfortable environment for everyone involved,you should strive to:

  1. Keep the discussion limited to he call.
  2. Start with what went right and give credit to everyone involved for their role.
  3. Identify problems without assigning blame to specific individuals.  For example, failure to give a medication in the appropriate amount of time is not solely the fault of the person giving the medication.  Blame lies with the person running the call, the person holding the drug kit, the person giving the medication, the person starting the IV, and the atmosphere of communication among the group in general: EMS calls are a team effort.  Caveat: don’t let this become the excuse for poor performance.

Learning from your calls does not have to be limited to that provided by the clinical education staff months later.  It can happen in just a few minutes following the call.   Whether it was run-of-the-mill, or the best/worst call you have ever run, you can learn things here. Give it a try.

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Written by ben

October 16th, 2008 at 4:22 pm

Posted in ideas,leadership

5 Responses to 'Debreifing difficult calls'

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