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Debriefing in der Kindernotfallversorgung

Grundlage einer verbesserten Patientenversorgung

Debriefing in pediatric emergency care

Basis for an improved patient care

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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Regelmäßige Debriefings (Nachbesprechungen) kritischer Ereignisse in der Kindernotfallversorgung können das Patienten-Outcome und die Teamzusammenarbeit verbessern. Die Reflexion ermöglicht Lernen in Teams, um in Zukunft besser zu werden und die Wiederholung von Fehlern zu vermeiden. Allerdings werden Debriefings im klinischen Alltag noch immer unregelmäßig und qualitativ unzureichend durchgeführt. Ursachen sind mangelnde Zeit, Fehlen erfahrener Debriefer und fehlende Unterstützung durch Verantwortungsträger. Debriefings können je nach Bedarf zu unterschiedlichen Zeitpunkten mit unterschiedlicher Dauer stattfinden: kurze „hot debriefings“ noch am Tag des Geschehens oder längere „cold debriefings“ einige Tage später. Im Mittelpunkt stehen immer das Lernen und Erarbeiten zukunftsorientierter Lösungen. Auslöser zur Durchführung von Debriefings können neben akut lebensbedrohlichen Ereignissen auch potenziell kritische Situationen, wie z. B. Intubationen, sein. Eine Strukturierung von Nachbesprechungen durch Debriefing-Skripte erleichtert die Durchführung und ermöglicht auch unerfahrenen Moderatoren, alle Aspekte abzuarbeiten. Neben der Diskussion schwieriger Abläufe sollten unbedingt positive Aspekte besprochen werden, um diese zu bestärken und das Lernen am positiven Beispiel zu ermöglichen. Dabei sollten die Beweggründe eines Verhaltens erfragt und nicht nur die nach außen sichtbaren Leistungen bewertet werden. Damit kann ein bedarfsorientiertes Lernen mit Erarbeitung von Lösungen stattfinden. Hilfreich sind spezielle Fragetechniken, ehrliches Interesse und eine positive Sicherheitskultur.

Abstract

Regular debriefings after critical events positively impact teamwork and patient outcomes in pediatric emergency care. Team reflection promotes learning, helps teams to improve, and prevents repeating mistakes in the future. Nevertheless, debriefings in daily practice may not exemplify quality standards. Reasons include lack of time, lack of experienced debriefers and lack of support from the key stakeholders. Debriefings can take place at different timepoints with variable duration as needed. Relatively short “hot debriefings” happen on the same day as events while longer “cold debriefings” occur several days later. Debriefings should focus on collaborative learning and future-oriented improvements. Not only acute life-threatening events may trigger debriefings, also potentially critical situations such as routine intubations warrant debriefing. Debriefing scripts promote a structured approach and allow even inexperienced moderators to navigate all aspects. In addition to areas of challenge, debriefings should explore and reinforce positive performance to facilitate learning from success. Debriefers should discuss not only obvious observable accomplishments, but also motivations behind key behaviors. This strategy promotes needs-based learning and focuses on solutions. Helpful strategies include specific questioning techniques, genuine interest and a positive safety culture.

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Correspondence to E. Heimberg.

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Interessenkonflikt

E. Heimberg, J. Daub, J.B. Schmutz, W. Eppich und F. Hoffmann sind als Trainer für Simulationskurse tätig und erhalten Honorar im Rahmen von Simulationskursen des Vereins PAEDSIM e. V.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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F. Hoffmann, München

F. Zepp, Mainz

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Heimberg, E., Daub, J., Schmutz, J.B. et al. Debriefing in der Kindernotfallversorgung. Monatsschr Kinderheilkd 168, 130–139 (2020). https://doi.org/10.1007/s00112-019-00831-9

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