Team debriefing in the COVID-19 pandemic: a qualitative study of a hospital-wide clinical event debriefing program and a novel qualitative model to analyze debriefing content.

BACKGROUND: Healthcare workers faced unique challenges during the early months of the COVID-19 pandemic which necessitated rapid adaptation. Clinical event debriefings (CEDs) are one tool that teams can use to reflect after events and identify opportunities for improving their performance and their processes. There are few reports of how teams have used CEDs in the COVID-19 pandemic. Our aim is to explore the issues discussed during COVID-19 CEDs and propose a framework model for qualitatively analyzing CEDs. METHODS: This was a descriptive, qualitative study of a hospital-wide CED program at a quaternary children's hospital between March and July 2020. CEDs were in-person, team-led, voluntary, scripted sessions using the Debriefing in Suspected COVID-19 to Encourage Reflection and Team Learning (DISCOVER-TooL). Debriefing content was qualitatively analyzed using constant comparative coding with an integrated deductive and inductive approach. A novel conceptual framework was proposed for understanding how debriefing content can be employed at various levels in a health system for learning and improvement. RESULTS: Thirty-one debriefings were performed and analyzed. Debriefings had a median of 7 debriefing participants, lasted a median of 10 min, and were associated with multiple systems-based process improvements. Fourteen themes and 25 subthemes were identified and categorized into a novel Input-Mediator-Output-Input Debriefing (IMOID) model. The most common themes included communication, coordination, situational awareness, team member roles, and clinical standards. CONCLUSIONS: Teams identified diverse issues in their debriefing discussions related to areas of high performance and opportunities for improvement in their care of COVID-19 patients. This model may help healthcare systems to understand how CED tools can be used to accelerate organizational learning to promote safety and improve outcomes in changing clinical environments.

Longitudinal evaluation of pediatric respiratory infections.

OBJECTIVE: Acute respiratory infections are the most common cause of under-five-year-old pediatric mortality worldwide. Due to a paucity of data, the impact of many respiratory viruses and their association with respiratory failure in children are unclear. We assessed single respiratory viral pathogens and their association with intubation, and secondly describe dual viral pathogens and viral-bacterial pathogens associations with intubation. PATIENT AND METHODS: This was a retrospective cross-sectional study of children (0-18 years old) admitted to the acute care unit and/or pediatric intensive care unit of an urban, quaternary children's hospital from November 1, 2013 to November 1, 2017. Patients with viral studies sent within 48 h of admission were included. Associations of viral pathogens and intubation status were calculated using odds ratios (OR), 95% confidence intervals (CI) and p-values. RESULTS: There were 15,923 hospitalization encounters, with 634 (3.9%) requiring intubation. RSV and hMPV had increased odds for intubation, (aOR 1.80, 95% CI 1.50-2.18) and (aOR 1.59, 95% CI 1.13-2.24) respectively. Coinfection with RSV and adenovirus had increased odds of requiring intubation, (aOR 3.48, 95% CI 1.21-10.01). Contrary, coinfection with influenza A and RSV had no intubations. In the viral-bacterial coinfections model, there was an increased association with intubations for RSV and Streptococcus (aOR 9.34, 95% CI 4.21-20.71) and hMPV and Streptococcus (aOR 8.98, 95% CI 1.62-49.88). CONCLUSION: RSV and hMPV corresponded to the highest rates of intubations, and dual infections with RSV and adenovirus, RSV and Streptococcus, and hMPV and Streptococcus were associated with mechanical ventilation, revealing differences amongst the groups.

Case Report of Unusual Facial Swelling in an 8-Month-Old.

Rhabdomyolysis is a potentially life-threatening disease defined by the release of intracellular contents into the body's circulation after muscle damage. It is most commonly seen in adult patients who present with crush injuries, overexertion, or prolonged immobility due to drug and/or alcohol overdose. Fortunately, it is rare in young children. We present the case of an 8-month-old girl with progressively worsening right-sided facial swelling that was associated with significant drooling and intraoral edema. The patient had been found lying prone and wedged between a mattress and the adjacent bedroom wall. After laboratory and imaging work-up, this child's injury was the result of prolonged facial muscle compression with resultant rhabdomyolysis. The patient improved during hospital admission with intravenous (IV) fluids, two days of steroids for facial swelling, and five days of antibiotics to treat superficial cellulitis. At 2-week follow-up, her swelling resolved with minimal residual facial scarring and a mild right facial nerve palsy. This patient's unusual history and clinical presentation challenges providers to explore rhabdomyolysis as a differential diagnosis in young children who present with localized severe swelling. Topics: Facial edema, rhabdomyolysis, facial cellulitis, non-accidental trauma.