| Description |
Background: Debriefing has emerged as an essential strategy in clinical settings to evaluate team performance, enhance learning, and identify opportunities for process improvement. It is a structured approach to reviewing technical aspects of patient care while facilitating the emotional processing of critical events and improving team dynamics. Despite its advantages, debriefing is often underutilized, and there is no universally accepted approach for conducting debriefs across clinical settings. Local Problem: In an adult intensive care unit at a large referral center, staff regularly engage in critical events involving patients enduring life-threatening diagnoses. Staff members often experience vocational stress related to these events, particularly when the opportunity to review technical performance and emotional impact is not provided following an event. The most common approach to debriefing primarily focuses on the technical dimensions of resuscitation efforts, neglecting the emotional consequences that critical events can have on staff. Methods: This quality improvement initiative used a pre-intervention survey to assess staff perceptions of and barriers to debriefing. An evidence-based debriefing tool was tailored for use at the site. Prior to implementation, an educational session was held to introduce a new debriefing process. Following a twelve-week implementation period, usability, feasibility, and staff satisfaction were assessed by comparing pre- and post-intervention survey responses and reviewing relative frequency of debriefs. Interventions: The debriefing toolkit included staff education, broadened criteria for debriefs, and a new debriefing form. Results: The reported frequency of debriefing following critical events increased, with 83% (n=14) of participating staff indicating that a debrief occurred at least half the time in post-survey responses (n=17), compared to 18% in pre-survey responses (n=50). Time was the most significant perceived barrier to debriefing. Staff comfort in leading debriefs increased from 28% (n=13) to 53% (n=9) among pre- and post-survey respondents. Additionally, 100% (n=17) of staff felt the new debriefing tool allowed for reflection on performance, and 94% (n=16) believed it facilitated discussions about the emotional impact of critical events, compared to 66% (n=33) and 16% (n=8), respectively, in pre-survey responses. These changes were statistically significant (p<0.01), and staff acceptance of the tool reflects the clinical significance of this change. Conclusion: Clinical use of the debriefing tool may increase the frequency of debriefs. Although there was a statistically significant increase in staff comfort with facilitating debriefs, 18% (n=3) remained uncomfortable leading debriefs, despite scripting and structure provided by the tool. Staff expressed that the debriefing tool provided an opportunity to address the emotional impact of critical events and unanimously supported its continued use. Moving forward, implementing an adapted version of this debriefing tool in various practice settings to meet the specific needs of each clinical environment should be explored to enhance team building and address the emotional challenges associated with clinical care during critical events. Future iterations of this project should focus on strategies to bolster staff confidence in facilitating debriefs, empowering all care team members to lead this vital process. |
