Abstract
Case Presentation of a Patient Who Had a Cesarean Hysterectomy:
Use of Interdisciplinary Case Debriefing to Identify Performance Improvement Opportunities
Using the case presentation format, also known as telling a story, is useful in making a clinical situation and didactic content more realistic and meaningful to the audience.  This is the story of a 38 year old para 5015 at 38 weeks gestation who was admitted for a repeat Cesarean Birth because of her diagnosis of a complete placental previa. Her case was scheduled in the General Operating Room (GOR) optimizing resources and space because of her increased risk for a placental acreta or percreta necessitating a cesarean hysterectomy. Obstetrical and Perioperative Staff collaborated with the preparations. After the birth of a healthy newborn weighing 7 pounds and 4 ounces with apgars of 8 at 1 minute and 5 at 10 minutes, the surgical team proceeded with a hysterectomy after confirming the diagnosis of a placenta percreta.  After a short stay in the Intensive Care Unit the mother did well and was discharged with her newborn.
Four days after the case, because of comments overheard on the clinical unit, a staff nurse recommended that an interdisciplinary debriefing be completed on this case. The process of debriefing is useful in providing involved staff with an opportunity to review the facts of the case, discuss team member perceptions and identify opportunities for system improvements, (that is lessons learned), that can be applied to future cases. Including all disciplines reinforces the unique role of each team member and provides a mechanism for the team to talk together informally about the case.  In this situation the team included the obstetrical staff, the perioperative staff and the Gyn oncology staff.
During the debriefing process the focus is on system improvements. The team considers patient factors, task factors, provider factors, team factors, and both unit and institutional environmental factors. Ideally this debriefing would occur as soon as possible after the clinical event but even though this debriefing occurred 20 days after the event it was still beneficial and the team identified several opportunities to better coordinate care for future cases. When it is feasible to “debrief” right after a clinical event it is an abbreviated approach can be used. Staff can discuss briefly, what went well, what they learned and what can be done better the next time.
The use of bedside interdisciplinary clinical debriefings is a helpful tool as it engages the clinical experts in identifying opportunities for making patient care safer while reinforcing the importance of input from all members of the team.