Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety

Abstract

Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A troublefree operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.

Postresuscitation debriefing in the pediatric emergency department: a national needs assessment

“…19 Our results indicate that despite the value placed on PRD by health care providors, PRD in Canadian pediatric EDs is underdeveloped, infrequently used, and insufficiently supported. Although there is growing evidence of the positive effect of debriefing after surgical, anesthetic, or critical care-based simulation events, [20][21][22][23][24][25][26][27][28] there is a lack of evidence on how PRD impacts teamwork and patient care in the ED. Our findings are consistent with an Australian study of pediatric ED physicians and nurses that identified a perceived need but a lack of a structured debriefing process.…”

“…The effectiveness of debriefing on achieving learning objectives has been studied, mostly outside the ED. [20][21][22][23][24][25][26][27][28] Simulation provides an active learning environment for health care providers to experience clinical situations and use cognitive, technical, and affective skills, such as those used in real-life resuscitation scenarios. 7,35 Systematic reviews of simulation literature identified feedback as the most important feature of simulation-based medical education.…”

Instrumentos Para Avaliar a Qualidade E Segurança No Bloco Operatório - Revisão Integrativa

“…Os indicadores de processo permitem avaliar a forma como um protocolo de cuidados de saúde é realizado ou prestado (5) . Dos artigos analisados são realçados instrumentos relevantes da área dos processos da avaliação da qualidade (11)(12)(13)(14)(15)(16)(17) .…”

“…Os conceitos "briefing e debriefing" são aplicados no estudo B6 (16) . Estes instrumentos têm sido utilizados entre os pilotos comerciais e de combate, e foram formalizadas para formação pela National Aeronautics and Space Administration (NASA), e agora aplicados à área da saúde, primeiramente nos blocos operatórios.…”

“…Ao longo deste momento, são reconstruidos todos os eventos com ênfase na segurança, comunicação, eficiência e potencial de melhoria. Estes instrumentos evidenciaram ter impacto na atitude da equipa e na segurança do doente (16) . Por último, "Os cinco passos para uma cirurgia segura" foram implementados no estudo B1 (11) .…”