Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project

Abstract

Hot debriefing (HoD) describes a structured team-based discussion which may be initiated following a significant event. Benefits may include improved teamwork, staff well-being and identification of learning opportunities. Existing literature indicates that while staff value HoD following significant events, it is infrequently undertaken in practice. Internationally, several frameworks for HoD have been developed, although none are widely adopted for use in the ED. A quality improvement project was conducted to introduce HoD into a single UK ED in North West England, between January and March 2019. Following stakeholder consultation, the 9-item ‘TAKE STOCK’ tool was developed. Implementation of the tool increased the number of HoD (0—2.2 HoD episodes/week). Findings from the first plan-do-study-act (PDSA) cycle are presented, which revealed the key strengths and limitations of this model. Staff perceptions of the tool were evaluated using a self-administered short questionnaire designed by the authors. Satisfaction with TAKE STOCK was assessed using 10-point numerical scales. Across respondents (n−15), average satisfaction scores exceeded 9 out of 10 concerning patient care, staff self-care, decision-making, education, teamwork and identification of equipment issues. Implementation of HoD into the ED is feasible and viewed as beneficial by staff. Implementation toolkits for TAKE STOCK have been requested by 42 additional UK hospitals and ambulance trusts, demonstrating significant interest in its use. Research is now required to formally validate HoD frameworks for use in the ED, and assess whether HoD results in sustained improvements to staff and patient outcomes.

Review DebrIeF: a collaborative distributed leadership approach to “hot debrief” after cardiac arrest in the emergency department – a quality improvement project

“…Structured team briefing protocals improve the performance of resuscitation teams in subsequent resuscitation events (Berg et al , 2020). In the UK, the two most commonly used team briefing protocols are STOP 5 (Jack and Walker, 2018) and Taking stock (Sugarman et al , 2021), with the latter being an adaptation of STOP 5. A structured debrief process may include the process and quality of care; review of quantitative data (CPR metrics); reflect on teamwork and leadership; and address emotional responses (Berg et al , 2020).…”

“…Quality improvement projects have been used successfully to support the implementation of a hot debrief in emergency departments, with reports that this has had a direct impact on improving the care to patients (Gilmartin et al, 2019(Gilmartin et al, , 2020Sugarman et al, 2021;Walker et al, 2020). However, there is very little evidence to identify if the improvement outcomes reported in these projects are sustained over time.…”

Implementing clinical debriefing programmes

“…Stakeholder interviews and a needs assessment process yielded a novel format for conducting locally relevant HoDs: the 'TAKE STOCK' model. 7 The authors defined criteria for an HoD as: unexpected death, paediatric standby, distressing event, staff request and unexpected outcome. The programme was developed at one institution, it has been shared freely under creative commons license across 42 ED and Ambulance trusts in the UK.…”

Debriefing in the emergency department

“…The team then progresses through guided group discussion: ‘S, summarize the case; T, things that went well; O, opportunities to improve; and P, points to action and responsibilities’ 8 . Application of action‐research cycles may yield frameworks that are more locally tailored, such as the TAKE STOCK framework 9 . However, as with the introduction of any new initiative, it requires departmental commitment – including medical, nursing and non‐clinical staff – to establish practices that remain consistent, even with staff turnover 2,9 .…”

“…Application of action‐research cycles may yield frameworks that are more locally tailored, such as the TAKE STOCK framework 9 . However, as with the introduction of any new initiative, it requires departmental commitment – including medical, nursing and non‐clinical staff – to establish practices that remain consistent, even with staff turnover 2,9 . The presence of clinical champions may support consistent implementation of hot debriefs during the initial phase of introduction as a routine practice.…”