Post Resuscitation Debriefings (And Keeping Them Brief)

Do you do a debriefing after each resuscitation?

This is a very important aspect of team performance and development. Teams that practice debriefings will find that by creating a safe and effective way to debrief, this will improve team development as well as improving patient safety. A debrief immediately after a resuscitation is important to review the goods, bads and important performance related issues that were encountered during a resuscitation. Some people will find there are challenges in doing debriefings after a resuscitation. Often there is a need to get to the next case or check on other patients, the lack of routine in doing debriefings, disorderly debriefs and even embarrassment or being shy to do a critic of a situation/event.

My recommendation is to develop a template/check list that will help organize a debrief and will keep it timely and brief.  It will encourage others to participate in the debriefing and provide a safe and inviting place to share thoughts and experience. Each section should take only a 2-3 minutes. Encourage people to be concise with their responses and keep it on task and professional.

The person leading the debrief does not necessarily have to be the leader of the resuscitation. In many debriefs I participate in, the senior nurse will often lead the conversation.

We only get proficient at doing debriefings with practice and good feedback. I will often ask at the end of my debriefings, “How did the debriefing go? Could I have done or said something differently?” I will only get better at this if I get honest, constructive feedback!!!

There are several templates available to use for debriefings but I believe sticking to this simple format is easily adopted and utilized in a busy department.

1. Introduction: All that were involved with the case should introduce themselves if the team is not familiar with each other  and discuss their role in the resuscitation. Example: “I’m Dr. Pepin. I was the resuscitation leader and I will be leading the debriefing.” Or, “I’m Jason, I was the ER tech assisting with chest compressions and applying the automatic compression device.”
2. Case Summary: The leader of the debriefing should summarize the case. Example: “This was a 44 year old male brought in to the ED via EMS for chest pain. Upon transfer from the EMS stretch to the bed he went into cardiac arrest with his initial cardiac rhythm being ventricular tachycardia. CPR was started until the defibrillator pads were applied. A single shock converted him to sinus tach with a pulse but he remained unconscious so he was intubated. ECG showed a STEMI and the cardiology team was made aware and the cath lab was activated. He was sent to the cath lab within 10 minutes of arrival.”
3. What went well?: This is the time for all team members to contribute and go around the room to discuss positive aspects of the case. This should include team work and leadership and not on the clinical aspects of the case. Example: “I really liked how there was great communication from David, the nurse documenting, as soon as we knew there was a STEMI we called cardiology.”
4. What could we have done better?: Again this should be all the team involved and this should be related to team work, leadership and communication and not clinical aspects. Example: “I really think we should have communicated better as a team when it came time to transfer the patient to the cath lab as to who was preparing the transport monitor, IV pumps and such.”
5. What could we do to improve in the future?: All the team should provide a comment on possible areas of improvement. Example: “I think we could have a check list for preparing patients for transport and assigned roles to make sure nothing is missed.”
6. Summarize the Debriefing: This is the perfect time for the team leader or lead debriefer to summarize the case and talk summarize the debriefing with three take away points.