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Chapter 33: Principles of Debriefing

Liana Zucco

INTRODUCTION

Debriefing is the practice of facilitated discussion between participants—reflecting on actions and thought processes. Distinct from feedback, or the one-way transfer of information, debriefing is a powerful tool that enables reflection, enhances operational efficiency, and improves clinical performance and interprofessional dynamics.1,2 Debriefing has increasingly been incorporated into healthcare settings, in training, and within real-time clinical practice. In obstetrics specifically, the implementation of routine debriefing programs has demonstrated improvement in clinical outcomes and is therefore recommended by the American College of Obstetrics and Gynecology as a tool to help prepare for and manage clinical emergencies.3

PURPOSE OF DEBRIEFING

  • To reflect on important components of routine care or a critical event, create a shared mental model, understand the thought processes leading to actions

  • To evaluate clinical workflow efficiency, facilitate interprofessional training, review clinical performance metrics, and promote continuous improvement, e.g., identify hazards within the workplace and propose risk mitigation strategies

  • To foster a culture of safety and cultivate an environment which acknowledges psychological burden and promotes provider wellbeing4

HOW TO DEBRIEF

Healthcare teams should consider the following when establishing a debriefing program in their organization:

  • A list of events that would trigger a debrief

  • The purpose of the debrief

  • The participants, facilitator(s), timing, and format

  • The content to be covered, the structure of the debriefing session, and the follow-up processes

These are summarized in Table 33-1. Furthermore, great care must be taken to appreciate the potential sensitive nature of debriefing, given preexisting concerns of punitive behavior and psychological distress.4

TABLE 33-1What to Consider When Debriefing in Obstetrics
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TABLE 33-1 What to Consider When Debriefing in Obstetrics

Trigger

Specific critical events (e.g., maternal death, hemorrhage, unplanned general anesthesia)

Purpose

Should be predetermined and agreed among the group

Often impacts how the remainder of the debrief is organized

Timing

Following an adverse clinical encounter:

  • Immediately; “hot”

  • Within a few hours or days; “warm”

  • Several days afterward; “cold”

After routine clinical care:

  • Per patient or end of the day

After an educational session:

  • Postsimulation training

Participants

Clinical staff:

  • All physicians and nursing staff (e.g., obstetrics, anesthesia, neonatology)

  • Therapists, pharmacists, technologists

  • Any other relevant clinical support staff, e.g., operating room staff

Nonclinical staff:

  • Hospital or departmental Quality and Safety or governance member

  • Other: social worker, mental health team member, clergy, unit coordinators

All staff members involved should be invited, all levels.

  • Organizations should respect the decision of those who do not wish to participate

Location

In-person:

  • A protected space, free from distraction

  • The exact site of the adverse event

  • An informal space: e.g., the hallway or on the labor and delivery unit

Virtual platform:

  • Enables larger participant group presence

  • Strict patient/provider data protection measures required

Content/Structure

Key elements that should be present within each debrief include:

  • Vocalization ...

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