What and when to debrief: a scoping review examining interprofessional clinical debriefing

Abstract

IntroductionClinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts.MethodsArticles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches.ResultsForty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD.ConclusionsThe proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

Routine versus prompted clinical debriefing: aligning aims, mechanisms and implementation

“…15 This is where the focus of the debrief is on giving participants space to focus on reactions to an event, rather than focusing on the experience itself in detail. Paxino et al's scoping review 9 excluded papers primarily describing psychologically focused debriefings, but noted that some of the included studies 'reported an intersection between quality improvement and supporting the emotional and psychological needs of team members'. Therefore, the aim of a prompted CD may be either to learn, to manage emotional responses or an amalgamation of both.…”

“…6 Our focus should now be shifting towards overcoming barriers to implementation, a disappointingly difficult feat. 7 8 The paper by Paxino et al 9 in this issue of BMJ Quality & Safety responds to this call and suggests that a lack of standardised terminology to describe CD practices may be part of the implementation problem.…”