Couper, Keith (2015) Debriefing for cardiac arrest. PhD thesis, University of Warwick.

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Abstract

Early data from North America supports the use of educational cardiac arrest debriefing as a strategy to improve the quality of cardiopulmonary resuscitation (CPR) in the hospital setting. As some debriefing approaches are challenging to deliver in the NHS setting, there was a need to develop debriefing approaches that are both effective and suited to NHS working practices. This thesis is modelled on the Medical Research Council framework for the development and evaluation of complex interventions. Undertaken between October 2011 and January 2015, it describes the development and feasibility assessment of three cardiac arrest debriefing approaches, which were specifically designed to be deliverable in NHS hospitals.

Development work comprised three work packages (systematic review, process evaluation, qualitative study). These studies provided evidence to support the use of cardiac arrest debriefing, but showed that weekly group debriefing is undeliverable in many NHS hospitals. Through qualitative work, I identified six distinct mechanisms by which debriefing may affect clinical practice. Synthesis of these data led to the development of three cardiac arrest debriefing approaches (monthly group debriefing, individual oral debriefing, written feedback).

We tested the feasibility of delivering these interventions by implementing them in three NHS hospitals (one intervention per hospital). In a before/after study, it was demonstrated that, despite practical challenges, interventions were deliverable in NHS hospitals. However, they were found to have no effect on either CPR quality or patient outcome. This finding was attributed to high performance in study hospitals at baseline.

This thesis demonstrates that the developed cardiac arrest debriefing interventions are deliverable in NHS hospitals. It has also generated important new theory about the mechanisms by which debriefing may affect clinical practice. This thesis lays the foundation for future work to evaluate the clinical and cost-effectiveness of these cardiac arrest debriefing interventions.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Cardiac arrest -- Treatment, CPR (First aid)
Official Date:	January 2015
Dates:	Date Event January 2015 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Perkins, Gavin D. ; Kirmani, Peter Kung'u ; Griffiths, Frances
Extent:	xii, 298 leaves : illustrations (colour), charts
Language:	eng

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