Critical Debrief: Clinical Event Debriefing

Critical Debrief: Episode 4: DEEP DIVE – Clinical Event Debriefing

What is clinical event debriefing, how does it differ from the simulation debriefing we all know, and how do you actually make it routine in a busy ED? Emergency clinicians Prof Walter Eppich and A/Prof Andrew Coggins join host Kit Rowe and the team for a deep dive.

Host: Kit Rowe  |  Panel: Pramod Chandru, Caroline Wilson  |  Guests: Prof Walter Eppich (University of Melbourne), A/Prof Andrew Coggins (Westmead)

Overview:

• The panel works through what “clinical event debriefing” (CED) really means and how it differs from simulation debriefing. It follows a real patient event, is rarely planned, and often happens when the team is most emotionally activated.
• A central thread is aligning intention with impact. They distinguish debriefing to learn, to manage, and to treat, and the risks of drifting into psychological treatment without the training for it.
• They argue for routine, brief, learning-oriented debriefs build the skills and psychological safety a team needs before the critical case arrives.
• Further discussions on who should facilitate teh debrief (and why it shouldn’t default to the team leader), end-of-shift check-ins, “coffee and cases,” M&M as after-action review, and “who debriefs the debriefers?”

Episode Timestamps

• 02:08 – What is clinical event debriefing?
• 03:04 – CED vs simulation debriefing
• 04:36 – Key differences: a real patient, usually unplanned, compressed time
• 09:09 – Is CED only for “sinister” events? Reconciling experience with its potential role
• 11:05 – Learning vs caring for traumatised staff; aligning intention and impact
• 14:51 – Support at 3am without a psychologist: psychological first aid (look, listen, link)
• 16:59 – The learn–manage–treat spectrum; the COVID-era genesis of the BMJ paper
• 21:46 – Who should lead a debrief?
• 27:34 – Debriefing the shift rather than the single event. Translational simulation
• 30:16 – The STOP5 hot-debrief tool
• 30:47 – What to ask in a routine end-of-shift debrief
• 32:08 – Pramod’s case (fat embolus, cardiac arrest)
• 33:21 – Andrew’s observational study; check-ins and building psychological safety
• 35:44 – Peer support and the loss of community on becoming a consultant
• 38:53 – Making sense of an event with a trusted colleague
• 41:28 – Preparing peers to debrief each other
• 43:46 – Community of practice; separating coaching/mentorship from debriefing
• 46:03 – Walter’s case story: an overnight paediatric tragedy and an informal debrief
• 48:35 – Structure and frameworks: use one, keep it simple; humility as a leader
• 51:01 – Shared understanding and ground rules as the core of a safe debrief
• 54:11 – Debriefing in retrieval medicine; “coffee and cases”
• 56:02 – “Just start debriefing”

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References & Resources (in order of discussion)

1. Kolbe M, Schmutz S, Seelandt JC, Eppich WJ, Schmutz JB. Team debriefings in healthcare: aligning intention and impact. BMJ. 2021 Sep 13;374:n2042.
2. Keiser NL, Arthur W. A meta-analysis of the effectiveness of the after-action review (or debrief) and factors that influence its effectiveness. J Appl Psychol. 2021 Jul;106(7):1007-1032.(~11:44)
3. Keiser NL, Arthur W Jr. A meta-analysis of task and training characteristics that contribute to or attenuate the effectiveness of the after-action review (or debrief). Journal of Business and Psychology. 2022. (~11:54)
4. Rose S, Cheng A. Charge nurse facilitated clinical debriefing in the emergency department. CJEM. 2018 Sep;20(5):781-785. (~22:24)
5. Walker CA, McGregor L, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med. 2020 Dec;7(4):259-266. (~30:16)
6. Coggins A, Santos AL, Zaklama R, Murphy M. Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes. BMC Emerg Med. 2020 Oct 7;20(1):79. (~33:21)
7. Petrosoniak A, Gabriel J, Purdy E. Stop asking if it works, start making it happen: exploring barriers to clinical event debriefing in the ED. CJEM. 2022 Nov;24(7):673-674.(~56:28)
8. Phillips EC, Smith SE, Tallentire V, Blair S. Systematic review of clinical debriefing tools: attributes and evidence for use. BMJ Qual Saf. 2024 Feb 19;33(3):187-198. (~57:14)
9. Schmutz JB, Lei Z, Eppich WJ. Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams. Acad Med. 2021 Sep 1;96(9):1337-1345. (~59:47)
10. Rose SC, Ashari NA, Davies JM, Solis L, O’Neill TA. Interprofessional clinical event debriefing-does it make a difference? Attitudes of emergency department care providers to INFO clinical event debriefings. CJEM. 2022 Nov;24(7):695-701. 

Background reading (referenced in planning; not discussed on air)

• Kessler DO, Cheng A, Mullan PC. Debriefing in the emergency department after clinical events: a practical guide. Ann Emerg Med. 2015 Jun;65(6):690-8. 
• Gillen J et al. The impact of a fellow-driven debriefing program after pediatric cardiac arrests. BMC Med Educ. 2019 Jul 22;19(1):272.

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