DEBRIEFING IN EVERYDAY
PRACTICE
Mara McErlean, MD
Patient Safety and Clinical Competency Center, Albany Medical Center
Acknowledgments
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Mary Carey
Heather Frenz
Cathy Manjunath
Dan Shovlin
Standardized Patients
PSCCC
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Albany Medical Center
Serves the educational needs of the Center
Standardized patients, task training and simulation
Opened in 2011
Debrief
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Definitions
Practical applications
Simulation video review
Small group discussion
Large group discussion
Summary
Definition
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de·brief
 To
question someone, typically a soldier or spy
 Details about a completed mission or undertaking
 Synonyms: cross-examine, interview, interrogate,
question, probe, examine, grill or pump
Originally used for soldiers returning from a
battlefield, for commanders to fully understand
a situation on the front line
 Done as soon as possible to get the freshest
information
 Communication largely from subordinate to
superior
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Became apparent that there was a benefit to other
soldiers to share experiences
Greater understanding of what happened when
shared as a group
Bolstering of individual and group identity
Now 1,060,000 results on Google
Many additional benefits
Clearer understanding for all
 Identification of future pitfalls
 Reinforces lessons learned through experience
 May decrease anxiety of experience
 Improves group dynamic and functioning
 Eases transition back into normal work duties
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American Counseling Association
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Seven Stages, 3-5 days post event, 2-3 hours
 Introduction
 Facts
 Thoughts
 Reactions
 Symptoms
 Teaching
 Re-entry
Critical Incident Stress Debriefing
1983
 Same seven steps
 Meant to help staff through significant,
stressful incidents
 Also delayed from time of incident
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Simulation Debrief
Discussion after a simulated event
 Designed to improve understanding
 To enhance future performance
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Traditional Simulation Debrief
Facilitated by someone with competence
 Done in a safe environment
 Facilitated by someone who witnessed the
experience
 Based on a structured framework
 Congruent with outcomes and objectives
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International Nursing Association
for Clinical Simulation and Learning
Four Es
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Debriefer encourages conversation about patterns
of behavior by asking learners to describe the
events that happened, the emotions around these
events, potential alternative viewpoints to
empathize and explanations for actions and
emotions.
Mayville 2011
GAS
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Ten minute approach designed to gather
information about how learners think and
feel about the session, analyze their
actions and summarize lessons learned.
O’Donnell 2009
Understand the “frame”
Assumptions
 Feelings
 Goals
 Knowledge
 Situation
 Awareness
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All drive individual behavior but sometimes are
not obvious to others.
“Good Judgment”
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Advocacy
 Observation,
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statement
Inquiry
 Question
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“I noticed when the nurse asked if we needed to
intubate, you responded by asking for lab results.
What were you thinking?”
Rudolph et al.
Good Judgment
Assume there is a reason for everything, even
if it is not apparent to you
 Be genuinely curious about why someone else
did what he/she did
 Assume everyone wants to do the “right” thing
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Rudolph
All day, every day
Every resuscitation
 Every code
 Every family conflict
 Every difficult encounter
 Maybe even some of the easy ones
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In fact….
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Debriefing is a critical component to continuous
quality assessment and improvement
Necessary for new staff
Equally necessary for seasoned staff
Useful in long term retention
Necessary for long term job satisfaction
Should be employed every day
Critical Elements of the Debrief
Safe
 Respectful
 Goal to understand a system
 Goal to improve functioning
 Goal to decrease hardship
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Start with yourself
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Assess your own reaction- identify your personal
frame
What did you witness
What problems do you identify
Who is the correct person to address
What do you want to be the outcome
Decide the right time and place
Deal with others
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Acknowledge the emotions first
Then work toward a shared understanding of what
actually happened
Assume the best intentions
Keep it personal- your observations and assessment
Keep it professional
Summarize often
Make an action plan
What we will do
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Show you a simulation that demonstrates a clinical
encounter
It is created, not real
Illustrates issues in daily clinical encounters
Your small groups will be asked to identify issues
Then a representative will talk about what you saw
Individual Debriefs
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Medical care (Covering MD-On-call MD)
Equipment (MD-RT supervisor)
Family dynamics (Bedside RN-Daughter)
Inter-professional communication (Bedside RNCharge RN)
Inter-professional communication (Bedside RN-MD)
Inter-professional communication (Bedside RN-RT)
Crisis recovery (Charge RN-Bedside RN)
Prepare your debrief
Choose your issue
 Choose your participants
 Prepare your opener
 Be ready to report to the group
 You have ten minutes
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Simulation Video
Summary
Debriefs do not have to be formal or
comprehensive
 Good managers and co-workers use debrief
techniques to process everyday occurrences
 A great method for continuous improvement for
patient care, the work environment and job
satisfaction
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THANK YOU!
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Special thanks to:
 Pat
Cumiskey
 Mark Dalton
 Kevin Gardner
 Lisa Taub
 Angie Potrikus
 Erin Waterhouse