Promoting hot debriefing in an emergency department

Abstract

IntroductionDebriefing is a process of communication that takes place between a team following a clinical case. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence as well as potential errors made. This helps to develop plans to improve subsequent performance. While the American Heart Association and the UK Resuscitation Council recommend debriefing following every cardiac arrest attended by a healthcare professional, it has not become part of everyday practice. In the emergency department (ED), this is in part attributable to time pressures and workload. Hot debriefing is a form of debriefing which should occur ‘there and then’ following a clinical event. The aim of this quality improvement project was to introduce hot debriefing to our ED following all cardiac arrests.MethodsA hot debriefing tool was designed following simulated cardiac arrest scenarios and team feedback. This tool was then introduced to the ED for use after all cardiac arrests. The team lead was asked to complete a debrief form. These completed hot debrief forms were collated monthly and compared with the department’s cardiac arrest register. Any changes made to cardiac arrest management following hot debriefing were recorded. Qualitative feedback was obtained through questionnaires.ResultsDuring the 6-month study period, 42% of all cardiac arrest cases were followed by a hot debrief. Practice changes were made to resus room equipment, practitioners’ non-technical skills and the department’s educational activities. 95% of participants felt the hot debriefing tool was of ‘just right’ duration, 100% felt the process helped with their clinical practice, and 90% felt they benefited psychologically from the process.ConclusionThe introduction of a hot debriefing tool in our department has led to real-world changes to cardiac arrest care. The process benefits participants’ clinical practice as well as psychological well-being.

Emergency clinicians’ knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings

“…During a period of promotion for ‘hot debriefs’ following cardiac arrest incidents in an Irish emergency department, the authors found that staff appreciated debriefing as a helpful tool for quality improvement and quality of patient care. However, it was noted that it was difficult to maintain high and consistent participation rates due to unawareness and/or forgetfulness [70] . A survey of US emergency medicine training program leaders found that barriers to debriefing of paediatric critical events included timing and scheduling of the clinical debrief [71] .…”

Debriefing in the emergency department

“…Debriefing can be utilised after any situation where it is expected to be of value for participants. It allows for discussion of individuals' and team performance during a traumatic event, promoting teams to analyse both clinical and communications performance, develop processes to improve subsequent experiences and mitigate the risk of future adverse outcomes 2 . Originating in the military, 3 it has also been used by other departments exposed to high risk events, including police.…”

“…The concept of the ‘hot’ debrief is one which takes place immediately after a significant incident, as compared with ‘warm’ (minutes to hours later), or ‘cold’ debriefs, which may take place days to weeks after an event 4 . Where a hot debrief can provide immediate team feedback between those involved in a critical event, it can be subject to the ‘hot’ emotional overlay of a traumatic resuscitation – these reactions can, however, be effectively utilised to identify processes that can be improved on, and in a timely fashion 2 . Hot debriefs also provide an opportunity for a ‘time‐out’ from the incessant clinical load of a busy shift and represent an important moment to consider the psychological needs of the individual and the team.…”

“…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.…”

“…After clinical cardiopulmonary resuscitation events, debriefing programmes have demonstrated improved rate of return of spontaneous circulation, neurologic outcomes, hands‐off compression times, and time delay to first compression 11 . Gilmartin et al 2 . found that after introducing a new programme to hot debrief after every cardiac arrest in their ED, the vast majority of their participants felt they benefited both clinically and psychologically from the process.…”