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Rapid Mortality Review as a Tool for Resident Debriefing in the Intensive Care Unit
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A6791 - Rapid Mortality Review as a Tool for Resident Debriefing in the Intensive Care Unit
Author Block: B. J. Garber1, W. Simon2, O. O. Amubieya1, T. H. Neville1; 1Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, CA, United States, 2Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
RATIONALE: Housestaff provide the bulk of care to dying patients in the intensive care unit (ICU). Despite this, the literature demonstrates few studies evaluating coping tools for those engaged with end of life care and death. Our housestaff have expressed a desire for more directed ICU debriefing.
METHODS: Our ICU has an established weekly quality improvement process of reviewing deaths called the Rapid Mortality Review (RMR). In the RMR housestaff provide a succinct case summary of the deaths from the previous week. Beginning October 2016, we added a debriefing component facilitated by a proctor or a Medicine Chief Resident. This activity employed two questions with the aim of providing additional support surrounding a patient’s death. First, we asked, “do you have any other concerns about how care was provided to this patient or find yourself notably bothered by this death for any other reason?” If yes, this was followed with, “do you feel comfortable saying more?” At the conclusion of the session the participants were provided a questionnaire that was anonymously completed.
RESULTS: On review of the survey data comprised of Likert questions (5 categories of response, from 1 = strongly disagree to 5 = strongly agree) and an open-ended question aimed at assessing the value of the debriefing exercise the response to the intervention was positive. When asked if “it helped me cope with the death of a patient” the average response was 3.82 (SD 0.61). In response to if the debrief was a “valuable use of time” the average response was 4.1 (SD 0.47). “The timing of the debrief” was felt to be appropriate with a response average of 4.1 (SD 0.61). The majority of the open ended answers to “what was useful or what could be improved” were positive with many expressing the value of timely reflection. Surprisingly when asked if they had discussed this death prior to their participation at the RMR session, 45% reported that they had no previous opportunity to outwardly reflect on the death of their patient.
CONCLUSIONS: Our experience with an RMR based approach to resident debriefing has been well received by housestaff. It offers a structured and timely opportunity for reflection that requires minimal resources or time investment. Moving forward efforts may be made to determine if debriefing sessions have an impact on the rates of burnout and the overall quality of life of housestaff while working in the ICU.
Author Block: B. J. Garber1, W. Simon2, O. O. Amubieya1, T. H. Neville1; 1Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, CA, United States, 2Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
RATIONALE: Housestaff provide the bulk of care to dying patients in the intensive care unit (ICU). Despite this, the literature demonstrates few studies evaluating coping tools for those engaged with end of life care and death. Our housestaff have expressed a desire for more directed ICU debriefing.
METHODS: Our ICU has an established weekly quality improvement process of reviewing deaths called the Rapid Mortality Review (RMR). In the RMR housestaff provide a succinct case summary of the deaths from the previous week. Beginning October 2016, we added a debriefing component facilitated by a proctor or a Medicine Chief Resident. This activity employed two questions with the aim of providing additional support surrounding a patient’s death. First, we asked, “do you have any other concerns about how care was provided to this patient or find yourself notably bothered by this death for any other reason?” If yes, this was followed with, “do you feel comfortable saying more?” At the conclusion of the session the participants were provided a questionnaire that was anonymously completed.
RESULTS: On review of the survey data comprised of Likert questions (5 categories of response, from 1 = strongly disagree to 5 = strongly agree) and an open-ended question aimed at assessing the value of the debriefing exercise the response to the intervention was positive. When asked if “it helped me cope with the death of a patient” the average response was 3.82 (SD 0.61). In response to if the debrief was a “valuable use of time” the average response was 4.1 (SD 0.47). “The timing of the debrief” was felt to be appropriate with a response average of 4.1 (SD 0.61). The majority of the open ended answers to “what was useful or what could be improved” were positive with many expressing the value of timely reflection. Surprisingly when asked if they had discussed this death prior to their participation at the RMR session, 45% reported that they had no previous opportunity to outwardly reflect on the death of their patient.
CONCLUSIONS: Our experience with an RMR based approach to resident debriefing has been well received by housestaff. It offers a structured and timely opportunity for reflection that requires minimal resources or time investment. Moving forward efforts may be made to determine if debriefing sessions have an impact on the rates of burnout and the overall quality of life of housestaff while working in the ICU.
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