Interdisciplinary medical teams often come together during high-stress, high-stakes situations and are expected to produce positive patient outcomes. This requires a well-functioning team. Debriefing fosters an environment for learning and serves as a tool to improve team performance and care processes.
A debriefing is structured communication, held shortly after an event or regularly, to discuss what happened during the event and why. Individual and team performance, what went well, and areas for improvement are reviewed. Group and individual learning are encouraged through reflection on performance (Salas et al., 2008). Debriefing can occur immediately after an event or sometime later. It allows teams to identify and improve gaps in care, potentially mitigating future patient harm (Salas et al., 2008; Gilmartin et al., 2020). The following article describes various aspects of debriefing including timing, advantages, and some practical tips.
Timing of Debriefings
Debriefings can be recurring or in response to an event. Recurring debriefings are conducted routinely, such as at the end of a shift (Salas et al., 2008). The focus is on what went well, what could have been done better, and what changes are necessary going forward.
For example, let’s say 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 of a medically stable patient 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 occur 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 documentation was done poorly because the documenter role had not been assigned. In fact, notes were scribbled on a paper towel. The team suggests the charge nurse could assign roles, listed on the neonatal code cart for easy reference, along with a cheat sheet for documentation. Leadership would create the cheat sheet and roll out the change. By debriefing, the team recognized the importance of defined roles and a documentation aid. In this and other cases, debriefing facilitates reflection on past actions and events, and it often generates ideas for improvement.
Hot versus Cold Debriefings
Hot debriefings take place immediately following a clinical event. Advantages of this approach include increased participation, improved recollection of events, and earlier mitigation efforts. Cold debriefings take place sometime later, which could be days or weeks, after an event. Advantages include the ability to bring in specialized debriefing facilitators and giving staff the space to process the event. However, not all staff involved may be able to attend and recall of events may not be as good.
Gilmartin et al. (2020) describe a quality improvement project in which a hot debriefing tool was introduced into an Emergency Room for use after cardiac arrests. Feedback was collected over a 6-month study period. As a result, additional equipment was purchased, malfunctioning O2 and CO2 sensors were replaced, and additional supplies were obtained to aid in airway management. A mobile whiteboard was implemented to facilitate improved documentation and situational awareness among all team members. Last, survey results showed that 100% of respondents reported an improvement or modification in their clinical practice, and 90% reported a psychological benefit from participating.
Practical Tips
As with handoffs and care transitions, a structured approach to debriefing is best, including using a checklist. Below is a checklist example from the Agency for Healthcare Research and Quality TeamSTEPPS® program (2013).
(Reprinted with permission from AHRQ TeamSTEPPS® 2.0 Pocket Guide)
Other suggestions include:
Assigning debriefing champions on each shift to ensure they take place
Beginning with a statement of debriefing purpose: to improve teamwork and patient care, and reinforce safe space
Keeping the debriefing brief (10-15 minutes)
Having a plan to relieve staff involved to enable them to participate
Copyright by Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS
*If this article interests you, you may also enjoy my book titled: Obstetric and Neonatal Quality and Safety (C-ONQS) Study Guide: A Practical Resource for Perinatal Nurses, available on amazon:
References:
Agency for Healthcare Research and Quality. (2012). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0. TeamSTEPPS Fundamentals Course: Module 4. Leading Teams. Retrieved from https://www.ahrq.gov/teamstepps/instructor/ fundamentals/module4/igleadership.html#im14
Agency for Healthcare Research and Quality. (2013). Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS®) 2.0 Pocket Guide. Retrieved from https://www. ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/ instructor/essentials/pocketguide.pdf
Gilmartin S., Martin L., Kenny S., Callanan I., Salter N.(2020). Promoting hot debriefing in an emergency department. BMJ Open Quality, 9:e000913, 1-5. doi:10.1136/ bmjoq-2020-000913
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