Clear guidance on how, when and when not to debrief teams in healthcare settings has been provided in a new article with co-author, Professor Walter Eppich, Chair of Simulation at RCSI.
The article, published in the British Medical Journal, follows a renewed focus on team debriefings to improve performance among healthcare providers during COVID-19. It recommends that aligning the purpose of debriefings with intended outcomes can reduce possible unintended harm.
Debriefings are common safety management and learning tools used in sectors associated with high levels of risk, such as aviation, the military and in hospitals. Healthcare debriefings are guided meetings during which members discuss, interpret and learn from recent clinical events, such as a patient fall or a cardiac arrest in a paediatric critical care unit. During COVID-19, debriefings also became increasingly common occurrences at end-of-shift in emergency departments and critical care units to encourage reflection and team learning.
In this article, the authors contrast debriefings with two different intentions: 'debriefings-to-learn' and 'debriefings-to-treat'. They recommend understanding differences between these two intentions, as each purpose requires a different approach to facilitate the debriefing.
Debriefings that aim to encourage learning can help teams learn quickly and manage patients more safely but strong emotional reactions to highly stressful events require skilled and deliberate interventions.
The authors build on previous evidence that indicates that group debriefings do not prevent post-traumatic stress disorder (PTSD), acute stress disorder (ASD) or anxiety and depressive symptoms. For example, clinicians treating critically ill patients during COVID-19 may experience prolonged, extreme situations that may trigger both acute and post-traumatic stress. The authors recommend that in such cases, team members should be supported to access specific therapeutic interventions guided by trained professionals.
If the purpose of the debrief is to treat distress, if strong emotional reactions and psychological distress are anticipated, or if the debriefing intentions are unclear, an alternative intervention: 'debriefing-to-manage', could be implemented. This approach facilitates listening, acknowledging and normalising reactions without pressing participants for details of the traumatic experience.
The importance of understanding debriefing intentions, and ensuring the intentions are aligned with the intended outcome, is critical. The following criteria guide facilitators when making the decision to debrief or not:
- Clarify who requests debriefing, why, and for what events. Ensure expectations are not mismatched.
- Analyse risks (e.g. re-exposure to traumatic event) and benefits (e.g. opportunity to learn as a team).
- Seek help in deciding whether to proceed and how to co-facilitate.
- Anticipate signs of potential distress and how to manage it.
- Reflect on boundary conditions: what support is available from the organisation to offer alternative help if team members show signs of distress? What prior experience with mutual reflection may team members have made?
The article was based on a study of literature and the combined experience of clinicians, crisis and team psychologists and healthcare educators who have been regularly debriefing in both clinical and simulated learning environments for more than a decade.
In addition to Professor Eppich from RCSI, the article was authored by scholars from Switzerland: Dr Michaela Kolbe and Dr Julia Seelandt, University Hospital Zurich; Dr Sven Schmutz, University Hospital Bern, and Dr Jan Schmutz, ETH Zurich.
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