The Pause That Heals: Strengthening Emergency Teams Through Post-Critical Event Debriefing

Makayla Pasternak

INTRODUCTION

• Providing debriefing opportunities allows for reflection after critical events to process these difficult experiences
• Absent debriefing after critical events reduces opportunities for emotional processing, team communication, and performance improvement
• Implementing debriefing sessions can provide a safe space for reflection, improved teamwork, and enhance nurses well-being

Clinical Question

How does implementing an educational intervention on post-critical event debriefing session utilizing a standardized debriefing form, compared to no education affect emergency department nurses’ confidence, team-based communication, and willingness to participate in debriefing over a 14-week preceptorship?

Population: Emergency department nurses

Intervention: Educational intervention on post-critical event debriefing using a standardized debriefing form

Comparison: No educational intervention

Outcome: Improved nurses-confidence, team-based communication, and participation in debriefing sessions

Time: 14 weeks

Methodology

• Databases: CINAHL, Google Scholar, PubMed, Rochester Ham Library
• Key words: Emergency department, debriefing, emergency critical events, critical-event debriefing, nurse well-being, and debriefing form
• Articles used: 7 articles

Literature Review

1. Real-Time Debriefing After Critical Events: Exploring the Gap Between Prinicple and Reality Arriaga et al (2020)
1. Level V: Review/ expert opinion (Primary source)
2. Relevance: Highlights the importance of “hot debriefing” and performing it within a timely manner. Additionally, the article also mentions the importance debriefing holds within team-based communication, reducing burnout, and enhancing patient safety.
1. Interdisciplinary Clinical Debriefing in the Emergency Department: An Observational Study of Learning Topics and Outcomes Coggins et al (2020)
1. IV: Observational study (Primary source)
2. Relevance: This journal emphasizes that structured interdisciplinary debriefing improves teamwork, communication, and quality improvement within the ED.

Literature Review

3. Psychological Debriefing of Hospital Emergency Personnel: Review of Critical Incident Stress Debriefing Elhart et al (2019)

• Level VI: Literature review (Secondary source)
• Relevance: Supports the use of Critical Incident Stress Debriefing (CISD) for emotional processing of these events. It also highlights the importance of mental health support and stress reduction.

4. Promoting Hot Debriefing In an Emergency Department Gilmartin et al (2024)

• Level IV: Quality improvement study (Primary source)
• Relevance: Demonstrates how hot debriefing following a critical event improves team performance, patient care, and staff well-being.

5. Clinical Team Debriefing Post-Critical Events: Perceptions, Benefits, and Barriers Among Learners Imperio et al (2024)

• Level V: Cross sectional study (Primary Source)
• Relevance: Highlights the importance of understanding debriefing practices in education and acute care settings. This method promotes emotional support, provides learning experience, and encourages team work.

Literature Review

6. Implementation and Facilitation of Post-Resuscitation on Debriefing: A Comparative Crossover Study of Two Post-Resuscitation Debriefing Frameworks Kam et al (2022)

• Level V: Comparative crossover study (Primary Source)
• Relevance: Demonstrates the effectiveness and benefits of both DISCERN and PCP structured tools. These methods both improve communication, emotional support, and education during debriefing.

7. Emergency Team Competencies: Scoping Review For the Development of a Tool to Support the Briefing and Debriefing activities of Emergency Healthcare Providers Lorenzini et al (2023)

• Level V: Scoping Review (Secondary source)
• Relevance: Supports the use of standardized competency-based debriefing tools (ETC). Supports debriefing because tit improves team performance, communication, and improved patient safety outcomes.

Valuable Topic 1: Benefits to Debriefing

Benefits include:

• Debriefing has been shown to enhance patient safety, improve team-based communication, and promote continuous learning opportunities.
• Provides feedback on medical education, patient care, and practice based learning with debriefing frameworks.
• Aids in identifying and addressing flawsm concerns that may impact the teams ability to perform the job, and identifying negative impact these events have on healthcare workers.
• Provides a safe space for learning experience.

(Arriaga et al., 2020; Coggins et al., 2020; Lorenzini et al., 2023)

Valuable Topic 2: Hot Debriefing

Hot debriefing:

• Hot debriefing is when the debriefing session is implemented quickly following the critical event.
• Timely debriefing allows for healthcare professionals to go over events that occurred while they are still fresh in participants minds.
• Contributes to addressing the psychological well-being amongst staff members
• Real-time debriefing contributes to the improvement of the team's ability to go over clinical actions, areas of improvement, and errors that were made.

(Arriaga et al., 2020; Gilmartin et al., 2024; Imperio et al., 2024)

Valuable Topic 3: Emotional Support and Well-Being

Emotional support:

• Frequent exposure to high-stress events —> burnout and stress
• Critical Incident Stress Debriefing (CISD) aids in helping healthcare professionals process and cope with the psychological response of critical events.
• CISD promotes resistance to stress reactions, builds resilience, and facilitates recovery from traumatic stress and return to a healthy function.
• Participants who engaged in debriefing reported improvements in their clinical practice and psychological well-being.

(Elhart et al., 2019; Gilmartin et al., 2024)

Significance to Clinical Issue

• ED nurses are frequently exposed to high-stress, traumatic events
• Burnout, emotional fatigue, impaired communication
• Lack of reflection following critical events can negatively impact nurse well-being and patient safety
• Debriefing after a critical event promotes
• Reflection and identification of areas of improvement
• Enhanced clinical skills and decision-making
• Opportunity to express emotion and find support
• Strengthens teamwork and communication within a fast-paced environment
• Debriefing supports continuous learning and growth

Theoretical Underpinnings

Kolb’s Experiential Learning Theory

• Learning is a continuous cycle: concrete experience —> reflection —> conceptualization —> application
• Individuals process their experiences differently, resulting in different learning styles
• In the emergency department, critical events serve as the concrete experience, while post-critical event debriefing supports reflective observation

Recommendation

• Debriefing following a critical event should occur after every critical event to make improvements
• Debriefing should occur directly following the event
• Provide ongoing education and training for nurses on how to lead/ participate in debriefing sessions
• Evaluate the effectiveness through getting feedback from the nurses, and measure outcomes

Intended Outcomes

• Improve ER nurses knowledge on critical-event debriefing and how to utilize the debriefing form
• Enhance team-based communication in the ED after a critical event
• Increase ED nurse engagement, confidence, and participation in debriefing sessions
• Promote consistent implementation of post-critical event debriefing to improve nurse well-being and patient safety

Independent Variable

Dependent Variable

Variables

Sample

Education on post-critical event debriefing and the proper utilization of a standardized debriefing form

Nurses confidence, knowledge, and participation in post-critical event debriefing

Emergency department nurses

Debriefing Form

• Debriefing form helps organize and guide the debriefing discussion
• Provides consistency and ensures all topics are hit
• The form includes a summary of the event, what went well, opportunities for improvement, enhance team-communication, and emotional support
• This form allows for debrieifng sessions to be more time efficient
• Normalizes reflection and encourages open communication

Data Collection

• Data was collected utilizing the Grundy’s C-scale which was given to nurses in the Emergency Department to assess their level of confidence participating in a debriefing session
• Nurses were provided with a pre- and post-survey to measure their confidence and willingness to participate in debriefing after the educational session
• Three additional open-ended questions were provided
• Which aspects of critical-event debriefing do you feel most confident in?
• How do team dynamics influence your experience during debriefing?
• Is there anything else you would like to share about your experience with post-critical event debriefing?

Dissemination

Sigma Research Day

Rochester Christian University Capstone Confrence

Henry Ford West Bloomfield ER

References

Arriaga, A., Szyld, D. Pian-Smith, MCM. (2020). Real-time debriefing after critical events: Exploring the gap between principle and reality. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7552980/

Coggins, A., Santos, A. D. L., Zaklama, R., & Murphy, M. (2020). Interdisciplinary clinical debriefing in the emergency department: An observational study of learning topics and outcomes. BMC Emergency Medicine, 20(1), 79. https://doi.org/10.1186/s12873-020-00370-7

Elhart, M. A., Dotson, J., & Smart, D. (2019). Psychological debriefing of hospital emergency personnel: Review of critical incident stress debriefing. International Journal of Nursing Student Scholarship, 6. https://journalhosting.ucalgary.ca/index.php/ijnss/article/view/68395/53131

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References

Gilmartin, S., Martin, L., Kenny, S., Callanan, I., & Salter, N. (2024). Promoting hot debriefing in an emergency department. BMJ open quality, 9(3), e000913. https://doi.org/10.1136/bmjoq-2020-000913

Imperio, M., Ireland, K., Xu, Y., Esteitie, R., Tan, L. D., & Alismail, A. (2024). Clinical team debriefing post-critical events: Perceptions, benefits, and barriers among learners. Frontiers in Medicine, 11, 1406988.https://doi.org/10.3389/fmed.2024.1406988

Kam, A., Gonsalves, C., Nordlund, S., Hale, S., Twiss, J., Cupido, C., Brar, M., & Parker, M. Implementation and facilitation of post-resuscitation debriefing: a comparative crossover study of two post-resuscitation debriefing frameworks. BMC Emerg Med 22, 152 (2022). https://doi.org/10.1186/s12873-022-00707-4

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References

Lorenzini, G., Zamboni, A., Gelati, L. et al. Emergency team competencies: scoping review for the development of a tool to support the briefing and debriefing activities of emergency healthcare providers. J Anesth Analg Crit Care 3, 24 (2023). https://doi.org/10.1186/s44158-023-00109-3

Purdy, E. R. (2024). Kolb’s Experiential Learning Model. EBSCO Information Services, Inc. https://www.ebsco.com/research-starters/education/kolbs-experiential-learning-model

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THANK YOU! ANY QUESTIONS?