Improving Safety Culture through Standardized Debriefing in a Medical Intensive Care Unit

Abstract

Problem: The Medical Intensive Care Unit (MICU) has a poor safety climate, suggesting the unit’s response following critical events is either absent or not disseminated to the staff. Despite organizational standards, the MICU completed one debriefing for over 100 qualifying events from July 2022-January 2023. Literature supports that failure to address poor safety climate can lead to drifts in clinical practice, failure to identify unit or system improvements, and adverse patient outcomes. Purpose: The purpose of this project is to assess implementation adherence of a standardized debriefing process to address unit safety climate. The project is expected to increase adherence to debriefings and identify, resolve, and disseminate quality improvements (QIs) reported in debriefings to improve patient and staff safety. Methods: Implementation occurred over 15 weeks in the Fall of 2023. Preceding the project start, an interdisciplinary team was mobilized. Twenty charge nurses received formal training on debriefing and qualifying critical events. The charge nurses were utilized as champions and followed the INFO debrief tool to debrief critical incidents. Unit-based committees reviewed the debriefings to establish sustainable resolutions, then disseminated the changes to staff through the unit’s communication platforms. Data was collected through weekly chart and Smartsheet audits to determine whether eligible events underwent debriefing. Project data was analyzed weekly by the project lead and run charts were used to analyze trends in data collected. Results: Pre-implementation data showed forty-two applicable events with 7% undergoing critical event debriefing. 0% of quality improvements were identified, resolved, or disseminated to staff. During the 15-week implementation period, compliance and median number of critical events debriefed was 66.6%. Three unit based QIs were identified and resolved, and two hospital wide QIs were identified and escalated. Conclusions: The project suggests that it is feasible to implement critical event debriefing in the intensive care unit and utilize charge nurses as champions. Variations in acuity, staffing, and leadership are influential in compliance. Debriefing successfully identifies QIs to be addressed and resolved at the unit and organizational level.