Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use

The Halloween Lateral Canthotomy Model

Audience: The Halloween Lateral Canthotomy Model” is designed to instruct Emergency Medicine residents PGY 1-4, as well as Emergency Medicine-bound students. Introduction: Although uncommon, retrobulbar hemorrhage associated with facial trauma is a potential cause of permanent vision loss due to orbital compartment syndrome. To prevent vision loss, treatment with lateral canthotomy is time-sensitive and to perform this procedure in an emergent setting requires properly trained practitioners. Objectives: The purpose of the model is to teach residents and students how to perform lateral canthotomy and to achieve competency in their skills. Method: Lateral canthotomy is an important skill to be proficient in for any Emergency Medicine Physician, as it is an uncommon, sight-saving procedure. It is indicated in scenarios of facial trauma that cause a retrobulbar hemorrhage. Patients are at risk for permanent vision loss due to acute orbital compartment syndrome if the procedure is not done expeditiously.1 A less likely cause of retrobulbar hemorrhage is spontaneous hemorrhage due to a bleeding disorder or anticoagulant use.2 The features of retrobulbar hemorrhage include acute loss of visual acuity, relative afferent pupillary defect, proptosis with resistance to retropulsion, increased intraocular pressure, and limited extra ocular movement.3 While the diagnosis is clinical, it can be confirmed by computed tomography (CT) and measurement of intraocular pressure.2 When the diagnosis is established, lateral canthotomy and cantholysis should be performed emergently. Cantholysis is contraindicated when a globe rupture is suspected or with an orbital blowout fracture. Potential complications of this procedure include iatrogenic injury to the globe or lateral rectus muscle, damage to the elevator aponeurosis resulting in ptosis, injury to the lacrimal gland and lacrimal artery, bleeding and infection.3 This task trainer uses affordable materials to let learners practice this rare, vision saving procedure

The Casserole Perimortem Caesarean Section Model

Audience: PGY 1-4 Emergency medicine residents, PGY 1-4 OB/Gyn residents and medical students intending to pursue these specialties. Introduction: Perimortem Caesarean sections (PCS) are infrequently occurring emergencies with far reaching repercussions for two patients (the fetus and the mother)1. Emergency physicians and trainees should know the theory and practice of this life saving procedure. PCS have traditionally been taught to residents in didactic lecture formats. Residents rotating on Labor and Delivery are further required to attend cesarean deliveries as a means of achieving competency in performing this procedure. However, the procedural technique of PCS is different from scheduled or even emergency caesarian sections. A review of partial task training models has illustrated a relative paucity of easily reproducible and standardized PCS models2. Thus, we developed an easily reproducible, low cost high-fidelity PCS model to train emergency medicine residents and other trainees. Objectives: To provide competence training for the perimortem caesarian section procedure. Methods: The PCS casserole model is a partial task trainer that has been designed with an aluminum turkey pan as a base, a gravid uterus designed from insulation foam and “Syn-Skin,” a subcutaneous layer made from gelatin and skin-colored latex. A baby doll simulates a fetus inside a turkey roasting bag with some plain water to simulate amniotic fluid

The Bubble-Wrap Peritonsillar Abscess Model

Audience: The Bubble-Wrap Peritonsillar Abscess Model is designed to instruct PGY 1-4 Emergency Medicine residents as well as Emergency Medicine-bound students. Introduction: Peritonsillar Abscesses (PTA) are frequently encountered in clinical practice. Emergent ENT consultation may not be possible. Emergency physicians must be able to perform needle aspiration of PTA. This procedure is fraught with risk due to the natural proximity of the internal jugular vein and carotid artery to the pharyngeal tonsils. Deliberate practice of clinical procedures can drastically reduce associated complications (Okuda et al., 2009); however, no simulators are available for this particular purpose. Here we describe a PTA model that can be used to practice PTA drainage by novice learners. Objectives: The basic purpose of the bubble-wrap PTA model is to teach learners competency in the needle aspiration of peritonsillar abscesses. Method: This model uses bubble wrap, zip ties, chicken broth and liquid latex to simulate a peritonsillar abscess. Learners are then able to perform a needle aspiration of the simulated abscess from start to the end with no risk to a live patient