Amazing and Awesome 1
Author: Chris Nickson
Peer reviewer: Judit Orosz
The Alfred ICU now has an ‘Amazing And Awesome’ project so that we can learn from the excellence that takes place every day in the workplace.
We even have a very ‘bling’ AAA slip collection box in the tea room:
Recently, three of our ICU nurses — Jayne Sheldrake, Chris Broadfoot, and Bridgina Mackay — helped facilitate and lead a ‘hot debrief’ after a crisis event. It was both ‘amazing’ and ‘awesome’ :-). Such debriefs seem to have a big impact, as they help us all understand what happened and why, help us support each other, and provide us all with an opportunity to reflect and start thinking about how we can do things even better.
So, how can we do a ‘hot debrief’ effectively?
Firstly, after a critical event, I like to make sure “all the loose ends are TIED up”…
- Team check (is everyone OK?)
- Ingest and imbibe (if possible, take a break to eat, drink, and recharge)
- Equipment resupply (be ready the next emergency)
- Debrief (soon after the event)
As for the debrief, our unit doesn’t (yet) have a specific protocolised approach to critical incident debriefing, so here’s what I try to do in 3 steps:
Step 1. Plan the debrief and give a prebrief
- TIE up the loose ends first and attend to patient care requirements
- Choose a facilitator (can be a doctor or a nurse, ideally with debriefing/ facilitation skills)
- Gather the team in a quiet and confidential space
- Establish the ground rules:
- We all worked hard and did our best, and we all want to do even better
- We want to understand what happened and why, support each other, and see what we can change for next time
- Everyone’s voice matters
- Everything discussed is confidential (the Chatham House rule applies)
- Explain who to contact if anyone needs more support or doesn’t feel comfortable speaking in front of everyone
Step 2. Have a “FAST” discussion (feelings/ facts, analysis, summary, take homes)
- Check initial reactions to how everyone is feeling.
- Go over the “facts” of the event (explain what happened and check that everyone is on the same page)
- Analyse any issues – often time is limited so a ‘learner-self assessment’ approach like ‘Plus-Delta’ is often suitable:
- “What aspects of the case went well?
- “What aspects of the case would we want to change?”
- Check if there are any outstanding issues after exploring these and ensure everyone has had an opportunity to have their say.
- Summarise the discussion
- Ask for take homes from the group
Step 3. “Close the loop”
- identify (and assign) any actions that need to be taken
- this may include things like checking in on people affected by the event, following up a patient’s outcome, reporting a sentinel event, instigating a guideline change, or filling out an ‘Amazing and Awesome’ slip and putting in the collection box…
All this should take only 10-15 minutes. There are non-trivial barriers to doing an effective ‘hot debrief’ (time, finding the right place to do it, getting everyone together, and having skilled facilitators) but we think it is important. It fits with our unit’s culture of supporting each other to take the best possible care of our patients, and to keep striving to get better. This is what post-event debriefing is all about.
Finding ways to improve clinical debriefing during our day-to-day work in the ICU will make for an exciting project… 😉
References and Resources
- Couper K, Perkins GD. Debriefing after resuscitation. Current opinion in critical care. 2013; 19(3):188-94. [pubmed]
- Kessler DO, Cheng A, Mullan PC. Debriefing in the emergency department after clinical events: a practical guide. Annals of emergency medicine. 2015; 65(6):690-8. [pubmed]
- Mullan P, Kessler D, Cheng A. Educational opportunities with postevent debriefing. JAMA. 2014;312(22):2333-2334. [pubmed]
- 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. doi: 10.15441/ceem.19.086. Epub 2020 Dec 31. [pubmed] [article]
FOAM and online resources
- AHA — Hot Debriefing Form Examples (PDF links available here: http://www.heart.org/HEARTORG/Professional/GetWithTheGuidelines/GetWithTheGuidelines-Resuscitation/Get-With-The-Guidelines-Resuscitation-Clinical-Tools_UCM_314499_Article.jsp – .WX_PW9OGOL1)
- Debrief2Learn — Podcast 005: Clinical Debriefing (2017)
- INTENSIVE — The Alfred ICU FAST-PAGE guide to debriefing (2015)
- LITFL — Clinical debriefing (2021)
- St Emlyns — It’s Good to Talk – Debrief in the Emergency Department (2013)