Modern healthcare organizations strive for continuous improvement in systems and processes to ensure safe, effective, and cost-conscious patient care. However, systems failures and inefficiencies lurk in every organization, often emerging only after patients have experienced harm or delays. Simulation and debriefing, focused on identifying systems gaps, can proactively lead to improvements in safety and quality. Systems-focused debriefing requires a different approach than traditional, learner-focused debriefing. We describe PEARLS for Systems Integration, a conceptual framework, debriefing structure and script that facilitators can use for systems-focused debriefing. The framework builds on Promoting Excellence And Reflective Learning in Simulation, using common debriefing strategies (plus/delta, focused facilitation, and directive feedback) in a modified format, with new debriefing scripts. Promoting Excellence And Reflective Learning in Simulation for System Integration offers a structured framework, adaptable for debriefing systems-focused simulations, to identify systems issues and maximize improvements in patient safety and quality.
From Foothills Medical Center (M.D.), Alberta Health Services; Cumming School of Medicine (M.D.), University of Calgary, Calgary, Alberta, Canada; Division of Emergency Medicine (J.R.), Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA; Process Improvement and eSIM (A.K.), Alberta Health Services; Department of Community Health Sciences (A.K.), Cumming School of Medicine, University of Calgary, Calgary; Department of Pediatrics and Emergency (A.C.), Medicine University of Calgary Alberta, Children's Hospital, Calgary, Alberta, Canada; Northwestern University Feinberg School of Medicine (W.E.), Chicago, IL; Department of Pediatrics (V.G.), Cumming School of Medicine, University of Calgary; KidSIM Pediatric Simulation Program (V.G.), Alberta Children's Hospital, Calgary, Alberta; and Division of Emergency Medicine (K.S.), Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
Reprints: Mirette Dubé, MSc, Alberta Health Services and University of Calgary, Foothills Medical Centre, 1403 29th Street NW, McCaig Tower, Room 04154 Calgary, AB, T2N 2T9 (e-mail: Mirette.Dube@albertahealthservices.ca).
V.G., W.E., and A.C. receive remuneration as faculty for the Debriefing Academy, which teaches debriefing courses.