Characteristics of Real-Time, Non-Critical Incident Debrie ng Practices in the Emergency Department

Abstract

IntroductionBenefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM).MethodsWe conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining >100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel.ResultsThe data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted.ConclusionThis survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2016

“…Similar to prior years, the most common study populations were medical students (21/75; 28%) and residents (48/75; 64%) . Interestingly, this year only one study addressing medical students was highlighted for excellence, in contrast to prior years.…”

“…Three of these studies with an experimental design were highlighted . There was a decline in the number of observational studies (35/75; 47%), compared to 2015 (36/61; 59%), but an increase in the number of studies using survey methodology (19/75; 25%) in 2016 compared to 10 of 61, 16% in 2015, and 0% in 2014. It should be noted that all survey studies in this review drew data from participants from multiple institutions per the predetermined selection criteria.…”

Debrief it all: a tool for inclusion of Safety-II

“…Routine debriefing also facilitates understanding of system resources and constraints [11]. Debriefing methods have been largely adopted and adapted from aviation and psychology and there are many models of both post-simulation and clinical event debriefing [11][12][13][14][15][16][17][18][19].…”

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care

“…Admittedly, debriefing in the clinical environment is not without its challenges. Competing patient care demands [ 24 ], lack of an appropriate space in the clinical area, disinterest by some team members, insufficient support from administration, and fear of being scrutinized for failures [ 25 ] can all pose barriers to successful implementation. Debriefing facilitators must create a psychologically safe environment to promote dialogue between all team members [ 20 ].…”