What Is A Debriefing?
A debriefing is structured communication, held shortly after an event or on a regular basis, to discuss what happened during the event and why. Individual and team performance, what went well, and areas for improvement are also discussed. Reflection on the experience encourages team and individual learning (Salas et al., 2008).
Why Is There A Need For Teams To Debrief?
Interdisciplinary medical teams are often required to come together in high-stress, high stake situations, with different team members, and produce positive patient outcomes. In order to achieve this, a well-functioning team is required. One mechanism to help foster optimum team performance is debriefing (Salas et.al, 2008).
When Can Debriefings be Done?
Debriefings can either be recurring or in response to an event. Recurring debriefs are conducted routinely, such as at the end of a shift, or daily (Salas et.al, 2008). The focus is on what went well, what could have been done better, and what changes are necessary for moving forward. For example, a team debriefing is held at the end of a day shift on labor and delivery:
The unit has two operating rooms, and during periods of high census/acuity with limited staffing, staff and management have found it’s better to use only one room at a time when clinically appropriate. On this day, both rooms were in use, one for a scheduled cesarean section (medically stable) and the other for a failed vacuum delivery, which left the unit short staffed. During the end-of-shift debriefing, the team identifies that the scheduled cesarean should have been delayed so the failed vacuum case could have gone first. The team identifies that better communication between the attending providers, resident, nurses, and charge nurse would have helped plan the order of the operations. Improved team communication was the takeaway.
Debriefings can also be conducted in response to an unexpected event (Salas et.al, 2008). Let’s use the example of a debriefing that occurs after a neonatal resuscitation. Overall the team performs well, but they identify that the documentation of the event was poorly done because there were no roles assigned including that of the documenter, and notes were scribbled on a paper towel. The team comes up with the idea of the charge nurse assigning roles, listed on the neonatal code cart for easy reference, along with a cheat sheet for documentation. Leadership helps to create the cheat sheet and roll out these changes. Team learning occurs related to the importance of defined roles in this event. Thus, debriefing facilitates reflection on actions and events and often generates ideas for improvement in moving forward.
Use of a Checklist in Debriefings
Like handoffs and care transitions, it is also recommended to use a structured approach to debriefing including a checklist. Below is an example of a checklist from the Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS program:
In summary, debriefings offer an opportunity to review team performance, identify what went well or problems encountered, enforce positive behaviors and generate ideas for improvement. Real-time learning through reflection on actions can occur and contribute to improved individual and team functioning.
(Reprinted with permission from AHRQ TeamSTEPPS 2.0 Pocket Guide)
References
Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J. S., Birnbach, D. J., Upshaw, C. (2008). Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips. The Joint Commission Journal on Quality and Patient Safety, 34(9), 518-527. doi:10.1016/s1553-7250(08)34066-5
Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. Agency for Healthcare Research and Quality (2012). TeamSTEPPS Fundamentals Course: Module 4. Leading Teams. Retrieved from https://www.ahrq.gov/teamstepps/instructor/fundamentals/module4/igleadership.html#im14
Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. Agency for Healthcare Research and Quality (2013). Pocket Guide TeamSTEPPS 2.0 Team Strategies & Tools to Enhance Performance and Patient Safety. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf
Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS