Team Reactions and Reflection Establishing a secure and reassuring environment is essential for team members to feel comfortable expressing themselves openly and honestly, regardless of their position, without the fear of retribution. Introducing the discussion with a statement that acknowledges the team’s capabilities, commitment, and shared goal of improvement can set a positive tone. Using the plus/delta method of debriefing, three fundamental questions can guide the reflection process: 1. What happened? 2. What went well? 3. What could be changed in the future? These questions are relatively simple and require limited training to implement. They allow both individuals and the team to reflect on the crisis event, identify performance deficiencies and safety gaps, and recognize opportunities for improvement in the healthcare system. Education Providing dedicated time and space for team members to reflect on the lessons learned from a critical event is a crucial aspect of debriefing. This reflection can lead to increased awareness and drive changes in future management at the individual, team, and health system levels. While debriefing includes feedback, there is a distinction between the two. Feedback focuses on performance compared to a standard of care, while debriefing is a reflective conversation about performance that may incorporate feedback as part of the process. Effective debriefing after a crisis event has the potential to address all six of the Accreditation Council for Graduate Medical Education (ACGME) core competencies, including medical knowledge, patient care, practice-based learning, interpersonal skills and communication, professionalism, and system-based practice. Resource Awareness Approximately 40% of healthcare professionals experience secondary trauma following a critical event. Proximal debriefing provides an opportunity to inform individuals who may be experiencing secondary trauma about available resources such as employee assistance programs
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and peer support. This allows team members to access support services if desired, without feeling obligated to discuss their emotions during the debriefing process. Even if team members choose not to utilize these services, they may still benefit from engaging in emotional discussions with their significant others, colleagues, mentors, or through personal reflection. Additionally, opportunities for closing the communication loop, such as follow-up, quality assurance, and quality improvement reporting, should be explored following the debriefing session. Conclusion Crises frequently occur in the hospital setting, contributing to provider burnout and compromising provider wellness. Debriefing after critical events is an essential component of experiential education that promotes teamwork and communication while addressing emotional implications. However, numerous barriers hinder its widespread implementation. Overcoming these barriers by prioritizing debriefing, training facilitators, fostering a supportive culture, and gaining administrative buy-in, is crucial. Integrating debriefing into crisis response plans and utilizing checklists and cognitive aids can facilitate its effective use. Overall, debriefing should be an essential component of comprehensive crisis response plans, fostering learning, well-being, teamwork, and patient safety.
Arriaga, A. F., Chen, Y. K., Pimentel, M. P. T., Bader, A. M., & Szyld, D. (2021). Critical event debriefing: a checklist for the aftermath. Current Opinion in Anaesthesiology, 34(6), 744-751. doi: 10.1097/ ACO.0000000000001061 2 Arriaga, A. F., Sweeney, R. E., Clapp, J. T., Muralidharan, M., Burson, R. C. 2nd, Gordon, E. K. B., Falk, S. A., Baranov, D. Y., & Fleisher, L. A. (2019). Failure to debrief after critical events in anesthesia is associated with failures in communication during the event. Anesthesiology, 130(6), 1039-1048. doi: 10.1097/ ALN.0000000000002649 3 Arriaga, A. F., Szyld, D., & Pian-Smith, M. C. M. (2020). Real-time debriefing after critical events: Exploring the gap between principle and reality. Anesthesiology Clinics, 38(4), 801-820. doi: 10.1016/j. anclin.2020.08.003 4 Finch, E. P., Langston, M., Erickson, D., & Pereira, K. (2019). Debriefing in the OR: A quality improvement project. AORN Journal, 109(3), 336-344. doi: 10.1002/aorn.12616. 5 Gilmartin, S., Martin, L., Kenny, S., Callanan, I., & Salter, N. (2020). Promoting hot debriefing in an emergency department. BMJ Open Quality, 9(3), e000913. doi: 10.1136/bmjoq-2020-000913
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