An Evaluation of a New Debriefing Framework: REFLECT

Abstract

Background Postresuscitation debriefing (PRD) is recommended by the American Heart Association guidelines but is infrequently performed. Prior studies have identified barriers for pediatric emergency medicine (PEM) fellows including lack of a standardized curriculum. Objective Our objective was to create and assess the feasibility of a time-limited, structured PRD framework entitled REFLECT: Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasize key points, Communicate clearly, and Transform the future. Methods Each PEM fellow (n = 9) at a single center was a team leader of a pre-intervention and post-intervention videotaped, simulated resuscitation followed by a facilitated team PRD. Our intervention was a 2-hour interactive, educational workshop on debriefing and the use of the REFLECT debriefing aid. Videos of the pre-intervention and post-intervention debriefings were blindly analyzed by video reviewers to assess for the presence of debriefing characteristics contained in the REFLECT debriefing aid. PEM fellow and team member assessments of the debriefings were completed after each pre-intervention and post-intervention simulation, and written evaluations by PEM fellows and team members were analyzed. Results All 9 PEM fellows completed the study. There was an improvement in the pre-intervention and post-intervention assessment of the REFLECT debriefing characteristics as determined by fellow perception (63% to 83%, P < 0.01) and team member perception (63% to 82%, P < 0.001). All debriefings lasted less than 5 minutes. There was no statistical difference between pre-intervention and post-intervention debriefing time (P = 1.00). Conclusions REFLECT is a feasible debriefing aid designed to incorporate evidence-based characteristics into a PRD.

Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19

“…The goal of the debriefing program was to engage with frontline clinicians to identify latent safety threats, discover improvement opportunities, address systems-level interventions, and involve administrative support staff [ 15 , 19 – 21 ]. Given that healthcare professionals reported increased levels of stress and anxiety during previous pandemics [ 22 ], this program could potentially create an opportunity to for team members to provide and receive peer support.…”

“…With efficiency of implementation in mind, the Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) tool [ 10 ] was selected. The researchers (JC.S and D.S) contacted two colleagues who had done research on the DISCERN tool and its subsequent adaptations [ 10 , 15 , 19 , 21 ] (P.C.M. and T.B.W-H.) and invited them to join the research team.…”

“…After this initial meeting, a first draft of the debriefing model was designed (JC.S and D.S.). A period of remote work with iterative feedback through four videoconferences incorporated the DISCERN tool [ 10 , 15 , 19 , 21 ] in the Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE), developed the overall structure and the scripted language of the debriefing form.…”

“…Interdisciplinary debriefing after cardiac arrest events has been shown to improve patient survival [ 13 ]. Despite the growing recognition of these conversations as a good practice, debriefings occur infrequently [ 14 , 15 ]. Cited obstacles to debriefing include a lack of time, a lack of trained facilitators, and a lack of debriefing locations [ 16 , 17 ].…”

Frameworks and quality measures used for debriefing in team-based simulation: a systematic review

“…In four studies, analysis of debrief videos was conducted using an existing tool: Brett-Fleegler et al 26 used the Debriefing Assessment for Simulation in Healthcare (DASH) with 114 simulation instructors to test validity and reliability, and Lammers et al 15 used a Root Cause Analysis (RCA) framework to examine the quality of RCA processes in a simulated prehospital paediatric emergency. Hull et al 17 used Objective Structured Assessment of Debriefing (OSAD) with expert debriefing evaluators and faculty debriefing, and Zinns et al 29 used the REFLECT postresuscitation debriefing framework.…”