Structured debriefing for codes and resuscitations

Continuous improvement and future performance of codes and resuscitations can be achieved with structured debriefing to provide feedback to participants by exploring teamwork, communication, technical aspects, equipment, and provide emotional release.

Goal

Provide non-threatening feedback to all team members to improve future performance and reduce anxiety.

Objectives of the debriefing

Explore teamwork and communication.

Discuss execution of codes or resuscitations, including aspects that can be improved during future efforts.

Emotional decompression if needed.

Environment

Who: Minimum participants include the code leader, principal nurses, respiratory therapist, and key assistants. Others should be invited if they were involved or observed the effort and have a desire to participate.

When: Optimal time is 30-60 minutes after the event. This gives participants time to finish any open duties and catch their breath. Beyond that that time, recall of specific events will fade and the team will disperse making it difficult to gather everyone.

Where: Away from the immediate patient care area with minimal disruptions.

Duration should last no more than 15-20 minutes. If a longer debriefing is needed an additional session should be arranged.

Psychological safety

Create a safe environment for team discussion: it is difficult to have one’s assumptions and practices challenged. Must not create shame. Approach errors as puzzles, not crimes: people do things for a reason, usually with a logic, even when not the best response. We are trying to identify the framework underlying suboptimal responses. Assume the best intentions of everyone; no one is trying to hurt patients. Transparency: goals of debriefing, demystify process (see introduction).

Suggested Sequence:

Introduction: demystify process: “We are going to talk about our experience today in a debriefing in order to learn from it. Please be mindful that it is difficult to talk about one’s mistakes, so please avoid judgmental language. Remember that everyone one of us is here to help patients, and now we are doing this debriefing to learn from our team’s experience.” What things did the team do well? What worked, that you want to do again in future? Subjective experience: To senior resident: “How would you describe your personal experience during the code?” Advocacy and inquiry: Team members may spontaneously bring up sub-optimal actions. Or you may need to introduce sub-optimal behaviors. “I noticed that it was difficult to give orders when you arrived with so many people in the room. How did you view the situation at the time?” Or, “I was thinking that some communication to bring order in the room may have helped you get to business quicker. Did you feel comfortable at that time to direct the crowd?”

References

Rudolph, JW, et al. Debriefing with Good Judgment: Combing Rigorous Feedback with Genuine Inquiry. Anesthesiology din 25(2007) 361-376. Jane Miller, PhD. Modified Delta Plus Method of debriefing.

Have you participated in a debriefing? Share your experience!