Creation and evaluation of a novel, interdisciplinary debriefing program using a design-based research approach.

BACKGROUND: The emergency department (ED) witnesses the close functioning of an interdisciplinary team in an unpredictable environment. High-stress situations can impact well-being and clinical practice both individually and as a team. Debriefing provides an opportunity for learning, validation, and conversation among individuals who may not typically discuss clinical experiences together. The current study examined how a debriefing program could be designed and implemented in the ED so as to help teams and individuals learn from unique, stressful incidents. METHODS: Based on the theory of workplace-based learning and a design-based research approach, the evolved nature of a debriefing program implemented in the real-life context of the ED was examined. Focus groups were used to collect data. We report the design of the debriefing intervention as well as the program outcomes in terms of provider's self-perceived roles in the program and program impact on provider's self-reported clinical practice as well as the redesign of the program based on said feedback. RESULTS: The themes of barriers to debriefing, provision of perspectives, psychological trauma, and nurturing of staff emerged from focus group sessions. Respondents identified barriers and concerns regarding debriefing, and based on this information, changes were made to the program, including offering of refresher sessions for debriefing, inclusion of additional staff members in the training, and remessaging the purpose of the program. CONCLUSIONS: Data from the study reinforced the need to increase the frequency and availability of debriefing didactics along with clarifying staff roles in the program. Future work will examine continued impact on provider practice and influence on departmental culture.

Workplace Violence and Harassment Against Emergency Medicine Residents.

INTRODUCTION: Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. METHODS: This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. RESULTS: A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. CONCLUSION: Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.