Understanding Debriefing: A Qualitative Study of Event Reconstruction at an Academic Medical Center

Abstract

Purpose This qualitative study sought to characterize the role of debriefing after real critical events among anesthesia residents at the Hospital of the University of Pennsylvania. Method From October 2016 to June 2017 and February to April 2018, the authors conducted 25 semistructured interviews with 24 anesthesia residents after they were involved in 25 unique critical events. Interviews focused on the experience of the event and the interactions that occurred thereafter. A codebook was generated through annotation, then used by 3 researchers in an iterative process to code interview transcripts. An explanatory model was developed using an abductive approach. Results In the aftermath of events, residents underwent a multistage process by which the nature of critical events and the role of residents in them were continuously reconstructed. Debriefing—if it occurred—was 1 stage in this process, which also included stages of internal dialogue, event documentation, and lessons learned. Negotiated in each stage were residents’ culpability, reputation, and the appropriateness of their affective response to events. Conclusions Debriefing is one of several stages of interaction that occur after a critical event; all stages play a role in shaping how the event is interpreted and remembered. Because of its dynamic role in constituting the nature of events and residents’ role in them, debriefing can be a high-stakes interaction for residents, which can contribute to their reluctance to engage in it. The function and quality of debriefing can be assessed in more insightful fashion by understanding its relation to the other stages of event reconstruction.

Real-Time Debriefing After Critical Events

“…This mixed-methods study was followed up with a qualitative study that further explored the interviews with anesthesia residents after actual critical events. 60 The interviews revealed that debriefing for the residents, in the setting of real events, was considered part of a multistage process that included internal dialogue, event documentation (as a component of reconstructing what happened), and lessons they felt they learned (not necessarily in this order or with distinct borders). In each stage of this process, there were residents who were self-negotiating their perceived reputation, affective response, and extent to which they internally felt culpable for what had happened.…”

“…This mixed-methods study was followed up with a qualitative study that further explored the interviews with anesthesia residents after actual critical events. 60 The interviews revealed that debriefing for the residents, in the setting of real events, was considered part of a multistage process that included internal dialogue, event documentation (as a component of reconstructing what happened), and lessons they felt they learned (not necessarily in this order or with distinct borders). In each stage of Box 2 Lessons from selected medical literature not specific to anesthesiology on the landscape and scarcity of debriefing after actual critical events A national survey of pediatric emergency medicine fellows regarding critically ill children in the emergency department (ED) showed that 99% of respondents had participated in medical resuscitations during their fellowship, yet more than 30% indicated that they had never participated in a debriefing session afterward; the majority estimated that postresuscitation debriefing in the ED took place 50% or less of the time.…”

Implementing clinical debriefing programmes

“…Demian Szyld , 1,2,3 Alexander F Arriaga 3,4,5,6 Critical event debriefing (CED) or 'hot debriefings' (HoDs) can be described as a trigger-based, immediate postevent, interprofessional, expertly facilitated conversation where clinicians recount, reflect on, and improve personally and as a team. 1 The process and experience of clinicians who cared for the patient is more complex and involves thoughts and emotions that go beyond the 'case' or 'resuscitation' and the debriefing itself.…”

“…1 The process and experience of clinicians who cared for the patient is more complex and involves thoughts and emotions that go beyond the 'case' or 'resuscitation' and the debriefing itself. 2 The American Heart Association guidelines for neonatal resuscitation highlight 'team debriefing' as a key step in their cognitive aid. 3 There is evidence that implementing a 'Cold Debrief ' programme for teams that care for patients in cardiac arrest improves outcomes 4 yet in practice 33% of events are routinely debriefed.…”

Helping healthcare teams to debrief effectively: associations of debriefers’ actions and participants’ reflections during team debriefings

“…However, many clinicians and educators report to struggle with leading debriefings 22 23. In spite of the versatile supply of tools for creating and maintaining inviting debriefing conditions,24–26 structuring debriefings7 27–37 and managing challenging debriefing situations,25 38 facilitating debriefings is perceived as difficult 22 23 39 40.…”