What Is the Purpose of an Administrative Review Debriefing Session After a Disaster?

• Periodical Listing
• Cureus
• v.12(6); 2020 Jun
• PMC7320638

Cureus. 2020 Jun; 12(6): e8822.

Critical Consequence Debriefing in a Community Hospital

Monitoring Editor: Alexander Muacevic and John R Adler

Chidiebere V Ugwu

^one Pediatrics, Woodhull Medical Eye, Brooklyn, USA

Marsha Medows

¹ Pediatrics, Woodhull Medical Center, Brooklyn, U.s.

² Pediatrics, New York University School of Medicine, New York, USA

Data Don-Pedro

ⁱ Pediatrics, Woodhull Medical Center, Brooklyn, USA

Joseph Chan

^ane Pediatrics, Woodhull Medical Middle, Brooklyn, U.s.a.

Received 2020 Jun 15; Accepted 2020 Jun 25.

Abstract

Introduction

Medical error is currently the third major crusade of death in the United states after cardiac disease and cancer^.A significant number of root cause analyses performed revealed that medical errors are mostly attributed to homo errors and advice gaps. Debriefing has been identified as a major tool used in identifying medical errors, improving advice, reviewing team performance, and providing emotional support post-obit a critical consequence. Despite being aware of the importance of debriefing, most healthcare providers fail to make use of this tool on a regular ground, and very few studies take been conducted in regard to the practise of debriefing. This study ascertains the frequency, current practice, and limitations of debriefing post-obit critical events in a customs hospital.

Pattern/Methods

This was a cross-sectional observational written report conducted amid attending physicians, physician assistants, residents, and nurses who piece of work in high acuity areas located in the study location. Data on electric current debriefing practices were obtained and analyzed using descriptive statistics.

Results

A total of 130 respondents participated in this study. Following a critical event in their department, 65 (l%) respondents reported lilliputian (<25% of the fourth dimension) or no exercise of debriefing and merely twenty (xv.4%) respondents reported frequent exercise (>75% of the time). Debriefing was washed more than than one time a week every bit reported by 35 (26.9%) of the respondents and was led by attention physicians 77 (59.2%). The debrief session sometimes occurred immediately following a critical event (46.ix%). Although 118 (90%) of the respondents feel that at that place is a need to receive some training on debriefing, only 51 (39%) of the respondents have received some form of formal preparation on the practice of debriefing. Among the healthcare providers who had some course of debriefing in their practice, the few debrief sessions held were to discuss medical management, place bug with systems/processes, and provide emotional support. Increased workload was identified by 92 (70.viii%) respondents as the major limitations to the practice of debriefing. Most respondents support that debriefing should be done immediately after a disquisitional event such as death of a patient (123 [94.half-dozen%]), trauma resuscitation (108 [83.1%]), cardiopulmonary arrest (122 [93.8%]), and multiple casualty/disasters (95 [73.1%]).

Conclusions

In order to reduce medical errors, hospitals and its management team must create an environment that will encourage all patient intendance workers to have a debriefing session post-obit every critical issue. This tin can be accomplished by organizing formal training, creating a template/format for debriefing, and encouraging all infirmary units to make this an integral role of their work procedure.

Keywords: debriefing, critical events, resuscitation, feedback

Introduction

The task of managing a critically ill patient can exist very enervating for medical personnel working in the intensive care unit and emergency room. I common action in both settings is resuscitation, which is defined as a series of interventions conducted by a trained team aimed at restoring and/or supporting vital function in a critically ill patient [1]. Due to the complexity of resuscitation processes, patient care is not always delivered optimally. Human systems and occupational sciences literature on the optimization of team operation suggest that debriefing following critical incidents can optimize team functioning [2-iv].

In the United states of america, medical error has become the tertiary major crusade of expiry following cardiac disease and cancer [5]. Several root crusade analyses performed revealed that medical errors are mostly attributed to errors of commission, omission, and advice [6]. Debriefing offers a healthcare team the opportunity to re-examine the clinical run into, discuss private and team performance, identify errors, and develop performance improvement strategies through reflective learning processes [vii-9]. Even though real-time clinical event debriefing tin be challenging to implement, it has been identified as an important aspect of effective clinical education, quality improvement, and systems learning. Debriefing tin can also aid protect and support those exposed to disquisitional incidents by minimizing aberrant stress responses [10]. Across its potential to improve individual and team functioning, the International Liaison Commission on Resuscitation (ILCOR) identified the impact of debriefing on actual patient outcomes as an important area of research [11]. Despite these endorsements, this educational intervention is all the same relatively novel in medicine. Few institutions have formal guidelines and standards on team debriefing after disquisitional incidents such equally a failed resuscitation [12-fourteen].

Debriefing is a conversational session that revolves around sharing and examining data later on a specific event has taken identify. It may follow a simulated or actual experience and provides a forum for the learners to reverberate on the experience and acquire from their mistakes [xv]. Originating from the military and aviation industry, debriefing is used daily to reverberate and meliorate the performance in other high-risk industries. Expert debriefers may facilitate the reflection past asking open-ended questions to probe into the framework of the learners and use lessons learned to future situations. Debriefing has been proven to meliorate clinical outcomes such equally the render of spontaneous circulation after cardiac abort and the teaching of teamwork and communication in pediatrics [13].

Debriefing is gratuitous of toll and has been perceived by most trainees equally useful. It has a do good of improving behavior and strengthening squad cohesiveness for improved quality and safe in everyday clinical practise [15,16].

Even with all these proven benefits, there is a paucity of data on the practice of debriefing amongst healthcare workers in a community hospital setting.

The aim of this written report was to appraise the current practice and limitations of debriefing and to define the all-time timing, effectiveness, need for training, use of established format, and expected goals of debriefing among wellness care workers in a community hospital.

Materials and methods

Study design

The researcher in collaboration with other experts designed a 20-question survey that independent inquiries about debriefing after a disquisitional event.

Healthcare workers with direct patient contact were recruited from adult and pediatric emergency rooms, adult intensive care unit, and neonatal intensive intendance unit, which had a high rate of disquisitional events at the report facility. Staff members working in these areas were approached at random by investigators request them if they will be interested in participating in a survey on debriefing. The individuals who agreed were taken to a private workspace surface area (e.g. consulting room behind closed doors) and given more information well-nigh the written report and a verbal consent obtained. Surveys were administered, giving respondents plenty fourth dimension and privacy to answer questions. This activity was carried out over a menses of ii months, which was plenty to capture virtually of the healthcare workers in those departments. Participation was voluntary and risk-free (as they were anonymous) and participants were given an option to cease at any time or choose non to answer whatever of the questions if they felt uncomfortable doing so. This study met the criteria for exempt condition after being reviewed by the institutional review board at the study facility.

Effect measures

Demographic data of each participant (position and years of clinical experience) was obtained. The current practise of debriefing after a critical result was collected, including data on who leads debriefing sessions, how often, how constructive, how soon or frequent, and what happens during debriefing sessions.

We also asked participants if they accept had whatever prior preparation, if there is a need for training, what kind of events should be debriefed, if they had any established format, if they experience debriefing was of import, and about their perceived goals and barriers to performing debriefing in their various departments.

Data analysis

The current practise, knowledge, and barriers to debriefing following a disquisitional event in a community hospital were assessed using descriptive statistical analysis. Data were compiled and analyzed using SPSS Statistics Version 25 (IBM Corp., Armonk, NY, USA).

Results

A total of 130 healthcare workers completed the survey. As presented in Figure1, majority, i.e., 43 (33%), of all respondents were nurses, whereas 38 (29%) were from internal medicine residents and 26 (20%) were pediatric residents. Most respondents, i.eastward., 52 (twoscore%), had less than two years of experience, whereas 32 (24%) reported having >ten years' experience in healthcare.

Part of respondents in the hospital.

Practice of debriefing

The frequency of debriefing is represented in Figureii. Most respondents, i.e., 65 (50%), reported to have never/rarely been part of a debriefing session, whereas only xx (15%) of respondents reported being always engaged in this practise.

Frequency of debriefing among respondents.

The practice of debriefing among healthcare providers in a community infirmary is shown in Table1. A good number of respondents currently debrief immediately after a critical upshot and are ordinarily led past the attending dr. involving more often than not clinical members of the squad. Discussions were mostly nigh medical management and identifying issues with systems and processes.

Tabular array 1

Practice of debriefing among respondents

Current Practices		n	%
Frequency of disquisitional event in your section?
	Once a week or more	35	27.iii
	Once in 2 weeks	29	22.7
	Once a month	28	21.9
	Rare (none in a month)	36	28.ane
Take you ever received any sort of preparation on debriefing?
	Yes	73	61.2
	No	50	38.viii
When exercise debriefings occur?
	Immediately following the upshot	61	47.vii
	24-72 hours after	30	23.4
	3-7 days	10	7.8
	After a week or later	1	0.8
	Departmental meetings	9	7.0
	Never	17	13.three
How constructive are debriefing sessions in your department?
	Very effective	39	33.nine
	Somewhat effective	57	49.6
	Not effective	xix	xvi.five
Who facilitates debriefing in your department?
	Attending physician	77	64.7
	Residents	23	19.3
	Nurse	7	5.9
	Social worker	1	0.8
	Other hospital staff/anyone	ii	1.vii
	Nobody	9	vii.6
Who attends debriefing sessions in your section?
	Attending physician
	Aye	92	70.viii
	No	38	29.two
	Doc assistants
	Yes	57	43.8
	No	73	56.2
	Residents
	Yeah	105	80.8
	No	25	nineteen.2
	Nurses
	Yes	84	64.6
	No	46	35.4
How effective are debriefing sessions in your section?
	Always constructive	111	85.iv
	Somewhat constructive	sixteen	12.iii
	Barely constructive	1	0.8
	I don't know	ii	one.5
Practice y'all recall in that location is a need for preparation on debriefing at your facility?
	Yeah	118	91.5
	No	11	eight.5
Practise yous accept a tool/template/format for debriefing?
	Yes	12	9.6
	No	113	xc.4

Cognition and attitude towards debriefing

The perception of the platonic practice of debriefing later on a critical issue is shown in Tableii. Most respondents agree that the practice of debriefing is very useful and is an important tool that will improve patient rubber outcome. Majority of respondents also agreed that this exercise should be conducted immediately without whatever filibuster. Debriefing sessions should be facilitated by an attending doctor, and disquisitional events such equally death of a patient, cardiopulmonary arrest, multiple casualty/disaster, and trauma resuscitation should be debriefed.​​​​​​​

Tabular array 2

Platonic do of debriefing

Ideal Practice		n	%
When should debriefings be conducted
	Immediately	102	78.v
	24-72 hours	23	17.7
	3-7 days	3	two.3
	At departmental meetings	ii	i.v
Who should facilitate debriefings
	Attention physician	75	57.7
	Residents	17	13.1
	Nurse	two	one.5
	Social worker	1	0.eight
	All healthcare workers	29	22.3
	Trained personnel	5	iii.8
What disquisitional events should be debriefed
	Death of a patient should be debriefed
	Aye	123	94.six
	No	7	5.4
	Trauma resuscitation should be debriefed
	Yes	108	83.1
	No	22	xvi.9
	Cardiopulmonary abort should be debriefed
	Yes	122	93.8
	No	8	6.2
	Shock should be debriefed
	Yes	86	66.2
	No	44	33.8
	Status epilepticus should be debriefed
	Yes	75	57.seven
	No	55	42.3
	Multiple casualty/disasters should be debriefed
	Yes	95	73.1
	No	35	26.9
	Debriefing is important for patient safety
	Yes	129	99.2
	No	1	0.8

The respondents reported that the goal of debriefing should be to review medical care, discuss errors, develop guidelines/protocols, discuss teamwork, build squad morale, and provide emotional support (Figure ​ iii).

Barriers to debriefing in a community hospital as reported by doctors and nurses are shown in Table3. Nigh respondents reported that they have not received any formal preparation on debriefing and agree that in that location is a need for i. Majority also reported that in that location is no template, format, or tool for debriefing. Increased workload was reported by the respondents as the major barrier to debriefing, whereas other barriers include lack of trained facilitators, lack of authoritative support, not feeling comfortable because of criticism, and lack of interest by team members.​​​​​​​

Table 3

Barriers to debriefing

Barriers	n	%
Workload
Yeah	92	seventy.viii
No	38	29.2
No identified interest/need
Yes	31	23.8
No	99	76.2
Lack of trained facilitators
Yes	45	34.6
No	85	65.4
No appropriate setting available
Yeah	27	20.8
No	103	79.two
Not comfortable discussing the event
Aye	18	thirteen.eight
No	112	86.2
Felt criticized/judged
Yeah	30	23.1
No	100	76.9
Too soon or too late
Yes	27	xx.8
No	103	79.two
Lack of authoritative back up
Yes	48	36.9
No	82	63.1

Give-and-take

Customs healthcare workers believe that critical outcome debriefing provides an artery to review medical care, hash out errors, develop guidelines, build team morale, and provide emotional support [17-20]. In clinical settings where debriefing is carried out effectively, at that place is bear witness that debriefing sessions can be used as an opportunity to foster learning and help healthcare workers reflect on both their personal and professional values and judgment. Effective debriefing sessions are aided by construction, support, and role-modeling [fourteen].

Although this report revealed that debriefing was done just a few times subsequently a critical event, healthcare workers mostly feel that debriefing should always occur after medical trauma or resuscitation [21,22]. Respondents in this study also prioritized multiple prey/disaster incidents and death of a patient as other events that should be debriefed. These critical events are perceived by healthcare workers as pitiful situations, with undesirable emotional impacts, and, in most cases, make the providers a second victim. Most providers agreed that debriefing is an important practice and that it has the potential to improve patient outcomes.

Similar to other studies, healthcare workers in this community infirmary felt that critical issue debriefing should happen immediately after the event and should be led past an attention physician [20,23]. The respondents also felt that discussion of medical management and identifying problems with systems and processes were generally handled during these sessions with less attention to emotional support. This may exist due to time constraint and people's inability/unwillingness to limited or communicate their feelings. However, it is of import to note that a brusk review study carried out by Timms in 2019 amidst emergency section (ED) providers concluded that although there was no prove about the efficacy of team debriefing in the ED, providers were desirous to have a debrief session subsequently critical events. She also proposed that more inquiry should be carried out to properly ascertain the benefits of debriefing [24].

Findings from this study indicate that nearly providers take never received whatever class of training on debriefing and strongly agree to the demand for such grooming. A training like this volition equip facilitators on how to run an efficient debriefing session, providing guidance on the key areas that need to be focused on. We as well believe that in that location is a need to inculcate lessons on debriefing into the curriculum of all healthcare workers during their professional training. Additionally, respondents reported that in that location was no format for debriefing in their departments and that they will prefer to utilise one. The utilise of format during debriefing serves every bit a guide that allows conversations to unfold in an orderly mode, promotes efficient utilise of time, keeps the give-and-take on track, and focuses the conversation on important learning objectives [23].

Majority of customs healthcare providers reported that barriers to debriefing were in line with those described in previous studies, which were more often than not due to increased workload and lack of trained facilitators or established guidelines [twenty,25]. This finding contrasts with that of a recent study that described communication as the major barrier in their clinical setting [26]. While the busy and e'er-changing temper of ED and critical care areas where these events happen remains unpredictable, nosotros believe that providing a structure for timely debriefing in the day-to-day schedule volition create an opportunity for less interference with piece of work activity.

Observing the impact and importance of debriefing in reducing medical errors, at that place is a demand for more big studies that are focused on efficacy of debriefing, best formats, setting, and timings, which volition yield the highest outcome. Debriefing should exist made a cadre part of medical didactics for current practitioners and students who are function of the healthcare manufacture.

Limitations

A cross-sectional report like this is discipline to non-response bias; participants had the option to opt out of the study if they did not feel comfy answering the questions. This can create a bias in the measured outcome. There is a possibility of a recollect bias, equally respondents were asked to recall their practise of debriefing over an unspecified menses. We had a limited number of respondents in this study every bit it was carried out in a community hospital with a low staff population; therefore, a larger study will be able to portray these practices with increased power. There is also a possibility of a volunteer bias, every bit the people that agreed to participate in this study may non be representative of the entire population.

Conclusions

Customs healthcare providers rarely practice debriefing even when they know it is an important tool. Although nigh of them do non have any standardized format or training on debriefing, they believe that debriefing afterwards critical events such equally patients' death and cardiopulmonary resuscitation will meliorate medical care and patient outcome. Debriefing being a vital tool in healthcare should exist fabricated a core part of training curriculum for its professionals.

Notes

The content published in Cureus is the result of clinical experience and/or enquiry by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of information or conclusions published herein. All content published inside Cureus is intended only for educational, research and reference purposes. Additionally, manufactures published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional person. Do not condone or avoid professional medical advice due to content published within Cureus.

The authors have alleged that no competing interests exist.

Human being Ideals

Consent was obtained past all participants in this written report. NYU School of Medicine issued approval s19-00180. The current IRB Status of your submission is: Canonical. This submission was reviewed by the NYU Schoolhouse of Medicine's lnstitutional Review Lath (lRB). During the review of your study, the IRB specifically considered : i. The risks and anticipated benefits (if any) to your subjects 2. The selection of subjects 3. The procedures for securing and documenting informed consent iv. The safety of your subjects 5. The privacy of your subjects and confidentiality of the data

Brute Ethics

Animal subjects: All authors have confirmed that this study did non involve animal subjects or tissue.

References

1. Fleisher GR, Ludwig South. Textbook of Pediatric Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. [Google Scholar]

ii. Campbell JO, Kuncel NR. Handbook of Industrial, Work & Organizational Psychology. Vol. 2. London: Blackwell; 2001. Individual and team training; pp. 278–312. [Google Scholar]

3. Cannon-Bowers JA. Making Decisions Under Stress: Implications for Individual and Team Grooming. Washington, DC: American Psychological Association; 1998. Individual and team decision making under stress: theoretical underpinnings; pp. 17–38. [Google Scholar]

4. Kozlowski SW, Bong BS. Handbook of Psychology: Industrial and Organizational. London: Wiley; 2003. Work groups and teams in organizations; pp. 333–375. [Google Scholar]

5. Medical mistake-the third leading cause of expiry in the US. Makary MA, Daniel One thousand. BMJ. 2016;353:2139. [PubMed] [Google Scholar]

6. Debunking the myth that the majority of medical errors are attributed to communication. Clapper TC, Ching One thousand. Med Educ. 2020;54:74–81. [PubMed] [Google Scholar]

vii. Educational opportunities with postevent debriefing. Mullan PC, Kessler DO, Cheng A. JAMA. 2014;312:2333–2334. [PubMed] [Google Scholar]

8. Debriefing medical teams: 12 testify-based best practices and tips. Salas E, Klein C, Male monarch H, et al. Jt Comm J Qual Patient Saf. 2008;34:518–527. [PubMed] [Google Scholar]

nine. Debriefing in fake-based learning: facilitating a reflective word. Arafeh JM, Hansen SS, Nichols A. J Perinat Neonatal Nurs. 2010;4:302–309. [PubMed] [Google Scholar]

xi. European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Soar J, Monsieurs KG, Ballance JH, et al. Resuscitation. 2010;81:1434–1444. [PubMed] [Google Scholar]

12. Psychological debriefing and the workplace: defining a concept, controversies and guidelines for intervention. Devilly GJ, Cotton fiber P. Australian Psychol. 2003;38:144–150. [Google Scholar]

thirteen. Debriefing afterwards failed paediatric resuscitation: a survey of electric current United kingdom of great britain and northern ireland practice. Republic of ireland S, Gilchrist J, Maconochie I. Emerg Med J. 2008;25:328–330. [PubMed] [Google Scholar]

14. Debriefing disquisitional incidents in the paediatric emergency department: current practice and perceived needs in Australia and New Zealand. Theophilos T, Magyar J, Babl FE. Emerg Med Australas. 2009;21:479–483. [PubMed] [Google Scholar]

16. Debriefing afterwards critical incidents for anaesthetic trainees. Tan H. Anaesth Intensive Care. 2005;33:768–772. [PubMed] [Google Scholar]

17. Deliberate do and the acquisition and maintenance of expert performance in medicine and related domains. Ericsson KA. Acad Med. 2004;10:70–81. [PubMed] [Google Scholar]

18. Implementation of an in situ qualitative debriefing tool for resuscitations. Mullan PC, Wuestner E, Kerr TD, Christopher DP, Patel B. Resuscitation. 2013;84:946–951. [PubMed] [Google Scholar]

19. Pediatric critical event debriefing in emergency medicine training: an opportunity for educational improvement. Nocera M, Merritt C. AEM Educ Train. 2017;ane:208–214. [PMC gratis article] [PubMed] [Google Scholar]

21. National survey of pediatric emergency medicine fellows on debriefing after medical resuscitations. Zinns LE, O'Connell KJ, Mullan PC, Ryan LM, Wratney AT. Pediatr Emerg Care. 2015;31:551–554. [PubMed] [Google Scholar]

22. Acceptability and implementation of debriefings afterwards trauma resuscitation. Berg GM, Hervey AM, Basham-Saif A, Parsons D, Acuna DL, Lippoldt D. J Trauma Nurs. 2014;21:201–208. [PubMed] [Google Scholar]

23. More than than one style to debrief: a critical review of healthcare simulation debriefing methods. Sawyer T, Eppich Westward, Brett-Fleegler M, Grant Five, Cheng A. Simul Healthc. 2016;11:209–217. [PubMed] [Google Scholar]

25. Importance of debriefing post-obit critical incidents. Healy S, Tyrrell M. Emerg Nurse. 2013;10:32–37. [PubMed] [Google Scholar]

26. Failure to debrief afterwards critical events in anesthesia is associated with failures in communication during the event. Arriaga AF, Sweeney RE, Clapp JT, et al. Anesthesiology. 2019;130:1039–1048. [PubMed] [Google Scholar]

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