Clinical event debriefing: a review of approaches and objectives

Abstract

Purpose of review This review explores four different approaches and clarifies objectives for debriefing after a clinical event in the emergency department. Psychological debriefing aims to prevent or reduce symptoms of traumatic stress and normalize recovery. Psychological first aid helps team members provide each other with pragmatic social support. Debriefing for simulation-based education promotes learning by team members. Quality improvement approaches and after action reviews focus on systems improvement. Recent findings Qualitative studies have begun to explore interactions between clinical staff after a significant clinical event. Clearer descriptions and measurements of quality improvements and the effect of clinical event debriefing on patient outcomes are appearing. An increasing number of studies describe melded, scripted approaches to the hot debrief. Summary Clinical staff have consistently indicated they value debriefing after a significant clinical event. Differing objectives from different approaches have translated into a wide variety of methods and a lack of clarity about relevant outcomes to measure. Recent descriptions of scripted approaches may clarify these objectives and pave the way for measuring relevant outcomes that demonstrate the effectiveness of and find the place for debriefing in the emergency department.

Systematic Debriefing for Critical Events Facilitates Team Dynamics, Education, and Process Improvement

“…Seminal papers regarding debriefing published by Mitchell10–13 describe critical incident stress debriefing (CISD). Although there has been much support and evidence for debriefing in the simulation setting, there is growing evidence on the outcomes of debriefing programs for hospital workers 14. Debriefing was first developed in the clinical setting to decrease the impact of psychological distress following a trauma 10–12.…”

“…Traditionally, most debriefing occurs with psychological trauma, simulation, and critical care areas focusing on victims rather than caregivers 14. Nurse leaders, however, recognized that the general care units and the procedural areas needed support.…”

“…Debriefings occurred Monday through Friday; therefore, not every critical event received a formal debriefing. Debriefings are considered “hot debriefs” when done immediately or soon after the event 13,14. In our debriefings, these occurred within an hour of the event based on the nurse leaders' availability.…”

“…Although there has been much support and evidence for debriefing in the simulation setting, there is growing evidence on the outcomes of debriefing programs for hospital workers. 14 Debriefing was first developed in the clinical setting to decrease the impact of psychological distress following a trauma. [10][11][12] Critical incident stress debriefing is a set of group crisis intervention tools designed to assist a homogeneous group of people after exposure to the same significant traumatic event.…”

“…While several guidelines include debriefing, there is limited evidence on its impact on health care providers and process outcomes. 1,7,14,17 A recent review recommended using debriefing sessions widely to help clinicians manage stress and improve outcomes from critical incidents. 17 There is growing evidence that clinical event debriefing effectively identifies educational needs and process outcomes.…”