Article 1
Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review. Harder N, et al. J Clin Nurs. 2020 Feb;29(3-4):330-346.
While debriefs are shown in previous literature to promote positive management of stress following a patient death, formal team debriefs inconsistently address the psychologic and emotional issues with a patient death. This is a scoping literature review of the topic of debriefing using the Cochrane Library, MEDLINE, CINAHL, PsycINFO, JBI and Scopus databases of English language publications through 2019. The authors looked included debriefs both in simulations and in actual clinical care. The specific aims were to looks at what kind of debriefing processes have been studied in the literature, and what are the psychological outcomes of providers who debrief after an unexpected death. 18 articles met inclusion criteria, 2 of which were reviews. Only 7 of these addressed debriefs in the non-simulation environment. All studies looked at psychological outcomes. General findings were that learning was negatively impacted by patient death in a scenario, but that cognitive load and emotional impact was alleviated by debriefing after such an event.
Five of the articles did not provide a formal description of their debriefing process though all articles indicated they had one. Of those with descriptions, there was a wide variety of methods including traditional (reaction/analysis/summary), death rounds, Plus/Delta, or other. There was no conclusion reached on the “best” method from this review. The authors identified a paucity of literature on addressing learners’ emotional reactions to patient death in the simulation environment, and on best practice for formal debriefing frameworks to address psychological safety in the clinical setting. This study is limited by the nature of it being a respective review, as well as being a mix of debriefs in both the clinical setting and in simulation scenarios. Because many papers used a different debrief method, no conclusions can be made on the best framework in either a simulation or clinical setting.
Article 2
Integration of Medical Legal Services into a Hospital-Based Violence Intervention Program: A Survey and Interview-Based Provider Needs Assessment. Sonnenberg J, et al. J Trauma Acute Care Surg. 2024 Mar 14.
Hospital-based violence intervention programs (HVIPs) aim to address the multifaceted barriers to recovery from violent injury and interrupt systemic cycles of violence in communities. There has been growing recognition of the need for legal support to address these social determinants of health experienced by victims of interpersonal violence. Medical legal partnerships exist nationally to provide legal assistance to address health-harming legal needs (HHLNs). Through surveys and participant interviews, this qualitative study explored the unmet legal needs of victims of violence and the barriers experienced by HVIPs in addressing HHLNs. A broad number of HHLNs were identified by the authors, including legal needs traditionally assessed by the I-HELP (Income, Housing and utilities, Education and employment, Legal status, and Personal and family stability) screening framework. Additionally, there were specific legal needs unique to victims of violence including criminal-legal issues, physical safety—especially in the setting of interpersonal violence—and police interactions. More than half of the HHLNs were brought to the attention of the HVIP team by patients or identified during discharge planning. Social work referral was the most common provider response to learning about an unmet HHLN. Less than 1 in 3 providers reported referring patients to outside legal organizations and providers expressed dissatisfaction with inability to address these challenges.
The journey to recovery for victims of violence extends beyond the doors of the hospital. The authors of this study have expertly demonstrated the myriad of unmet legal needs that complicate healing and place patients at risk for recurrent violent injury. Collaboration between medical legal partnerships and HVIPs can facilitate meaningful recovery by leveraging the expertise of legal teams to navigate the bureaucratic red tape experienced by victims of violence. The authors identify additional challenges which must be addressed. First, standardized screening for HHLNs must be incorporated into the assessment of traumatically injured patients. The identified issues faced by victims of violence extend beyond traditional screening tools, such as the I-HELP framework, and screening must be tailored to the specific needs of this population. Additionally, addressing these unmet legal problems must consider local challenges and incorporate existing legal resources to maximize impact without duplicating efforts. Empowering providers with the knowledge, not only of unmet legal needs, but also about local resources may be more than half the battle. Incorporating legal experts into the services offered by HVIPs has potential to address the social determinants of violent injury.
Article 3
Reliability of the safety threats and adverse events in trauma (STAT) taxonomy using trauma video review. Nazir A, Baletic N, Dumas RP, Fitzgerald C, Xu K, McGowan M, Nolan B. Eur J Trauma Emerg Surg. 2024 Apr;50(2):497-504.
Video review of trauma resuscitations is becoming a common practice that allows for identification of adverse events and subsequent quality improvement initiatives to correct them. This study developed the Safety Threat and Adverse events in Trauma (STAT) taxonomy to classify errors in trauma resuscitation identified in video recordings. Initial findings from a literature review were then refined via two rounds of online surveys and a panel of 22 trauma experts. The final STAT taxonomy group divided 65 adverse events into nine categories including (1) EMS handover, (2) airway and breathing, (3) assessment of injuries, (4) disposition, (5) procedure related, (6) team communication and dynamics, (7) patient monitoring and access, (8) management of injuries, (9) circulation. The article provides a thorough explanation of the implementation and validation of the STAT taxonomy review. The most common adverse events were (1) Failure to measure temperature (86.7%), (2) Inadequate personal protective equipment (86.7%), and (3) Inability to use closed-loop communication (76.7%).
The limitations of this single-center pilot study are related to its small sample size and uniformity of reviewers. These limitations should not detract from the overall results The adverse events identified on video review, including inadequate personal protective equipment and lack of closed-loop communication are inevitably ubiquitous in trauma centers across the country. The development and validation of the STAT taxonomy is the more impactful outcome of this study and has the potential to improve patient care and research standardization across institutions. With more trauma programs utilizing trauma resuscitation video review, this taxonomy providers a useful tool for implementation, providing a standardized review system that allows for objective assessment of resuscitations. The results have the potential to generate valuable data for performance improvement of trauma resuscitations and to decrease adverse events. The objective nature and data driven feedback would also be useful in limiting recall bias from participants in the resuscitations. Adverse events occur for many reasons during trauma resuscitations. Utilizing video reviews with the STAT taxonomy shows promise in identifying and mitigating their occurrences, ultimately improving patient care.
