Okay, let's talk - short debriefings in the operating room

What and when to debrief: a scoping review examining interprofessional clinical debriefing

INTRODUCTION

Clinical debriefing (CD) improves teamwork and patient care. It is implemented across a range of clinical contexts, but delivery and structure are variable. Furthermore, terminology to describe CD is also inconsistent and often ambiguous. This variability and the lack of clear terminology obstructs understanding and normalisation in practice. This review seeks to examine the contextual factors relating to different CD approaches with the aim to differentiate them to align with the needs of different clinical contexts.

METHODS

Articles describing CD were extracted from Medline, CINAHL, ERIC, PubMed, PsychINFO and Academic Search Complete. Empirical studies describing CD that involved two or more professions were eligible for inclusion. Included papers were charted and analysed using the Who-What-When-Where-Why-How model to examine contextual factors which were then used to develop categories of CD. Factors relating to what prompted debriefing and when debriefing occurred were used to differentiate CD approaches.

RESULTS

Forty-six papers were identified. CD was identified as either prompted or routine, and within these overarching categories debriefing was further differentiated by the timing of the debrief. Prompted CD was either immediate or delayed and routine CD was postoperative or end of shift. Some contextual factors were unique to each category while others were relatively heterogeneous. These categories help clarify the alignment between the context and the intention of CD.

CONCLUSIONS

The proposed categories offer a practical way to examine and discuss CD which may inform decisions about implementation. By differentiating CD according to relevant contextual factors, these categories may reduce confusion which currently hinders discourse and implementation. The findings from this review promote context-specific language and a shift away from conceptions of CD that embody a one-size-fits-all approach.

'Herding cats': A mixed methods investigation into the educational value of debriefing in operating theatres

AIM

The aim of the study was to explore the value of debriefing to enhance learning within operating theatres.

METHODS

A sequential mixed method study was undertaken at a local District General Hospital Trust in 2020. A total of 106 surveys were distributed to all multidisciplinary team members based in the trauma and orthopaedic theatres. Following the survey stage, 11 in-depth semi-structured qualitative interviews were undertaken with volunteers from the survey stage which included a range of health care professionals.

FINDINGS

Participants identified debriefing as a valuable tool for learning and reflection. However, significant barriers were identified, including lack of time and conflicting priorities. Some interviewees referred to the current debriefing process as a 'tick box' and a 'herding cats' exercise, attributing it to a lack of structure, leadership and organisational buy-in.

CONCLUSIONS

Debriefing in the operating theatre is a valuable tool for individual and team learning. However, formalising the structure of the debriefing, along with joint team and organisational commitment, was deemed vital in optimising the value of debriefings in the future.

Debriefing to improve interprofessional teamwork in the operating room: A systematic review

PURPOSE

Debriefing has been pivotal in medical simulation training, but its application to the real-world operating room environment has been challenging. We reviewed the literature on routine surgical debriefing with special reference to its implementation, barriers, and effectiveness.

DESIGN

Descriptive systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Inclusion criteria were papers pertaining to debriefing in routine surgical practice. Excluded were papers reporting simulation training. We searched Google Scholar, CINAHL, Web of Science Core Collection, PsychINFO, Medline, Embase, and ProQuest Theses & Dissertations Global. The last search was performed on March 14, 2022. Quality was assessed on a 21-point checklist adapted from a standard reporting guideline. Synthesis was descriptive.

FINDINGS

The search process resulted in 19 papers. Publication dates ranged from 2007-2022. Study methods included surveys, interviews, and analysis of administrative data. Five papers involved a specific intervention. Quality scores ranged from 12-19 out of 21. On synthesis, we identified five topics: explanations of how debriefing had been implemented; the value of coaching and audit; the learning dimensions of debriefing, both team learning and quality improvement at the organizational level; the effect of debriefing on patient safety or the organization's culture; and barriers to debriefing.

CONCLUSIONS

Successful implementation programs were characterized by strong commitment from management and support by frontline workers. Integration with administrative quality and safety processes, and information feedback to frontline workers are fundamental to successful debriefing programs.

CLINICAL RELEVANCE

Debriefing can improve teamwork, learning, and psychological safety but is difficult to practice in the operating room environment. It is relevant to review the benefits and barriers to debriefing, and to learn from the experience of others, in order to run better debriefing models in our own hospitals.

Risky Decision Making Due to Goal Conflicts in Firefighting—Debriefing as a Countermeasure to Enhance Safety Behavior

Firefighters act within extreme environments, work under threatening conditions and are often exposed to goal conflicts (e.g., self-protection vs. mission objective) during their missions. However, what are the consequences of these safety and task goal conflicts, and what countermeasures could help to reduce their occurrence? In an online survey, 340 firefighters were asked about goal conflicts, risky decision making, debriefings and the frequency of difficulties in teamwork during firefighting. Associations between the survey variables were determined by multivariate regression and mediation analyses. Data show that goal conflicts were associated with risky decision making and unsafe acts. Furthermore, debriefings were associated with fewer goal conflicts, as mediated by less-frequent difficulties with teamwork (communication, leadership and shared mental models). Though limited by the cross-sectional design of our study, the results provide evidence that debriefing is a valuable tool to reduce difficulties experienced with teamwork on missions and therefore reduce the occurrence of conflicting goals. Fewer goal conflicts are associated with a decrease in unsafe decisions and, thus, a safer working environment for firefighters. Accordingly, it is recommended to conduct debriefings, with an increased focus on team aspects.