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“Debriefing of cardiac arrest events, either in isolation or as part of an organized response system, improves subsequent CPR performance in-hospital and results in higher rate of return of spontaneous circulation (ROSC). Debriefing of actual resuscitation events can be a useful strategy to improve future performance (Class IIa, LOE C). Additional research on how best to teach and implement post event debriefing is warranted.”
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David Hiltz, NREMT-PMike Smith, MPH, EMT-B
American Heart AssociationEmergency Cardiovascular Care Programs
DEBRIEFING ANDCARDIAC ARRESTQUALITY IMPROVEMENT
OBJECTIVES
ANOBVIOUS INFLUENCE
HOUSTON, WE DO HAVE A PROBLEM!
PROBLEMS AT A GLANCE PART 1
PROBLEMS AT A GLANCE PART 2
The
DISPARITY
SURVIVAL TO DISCHARGE
“IS ALL OVER THE MAP”
BUT NOT ANUNSOLVABLE PROBLEM!
DEVELOPING A CULTURE OF EXCELLENCE
BASTARD LIFESAVER
S
I HATEWAITIN
G!DAMN EMTS
WE CAN DO EVEN BETTER!
A NECESSARY COMBINATION!
A QUICK WORD…CAN’T WE SOLVE OUR
PROBLEMS WITH TECHNOLOGY?
A COMMON MISCONCEPTION!
DEBRIEFING IS CHEAP!
Debriefing of cardiac arrest events, either in isolation or as part of an
organized response system, improves subsequent
CPR performance in-hospital and results in higher rate of return of spontaneous circulation (ROSC). Debriefing of actual resuscitation events can be a useful strategy to
improvefuture performance (Class IIa, LOE
C).
Innovative concepts to reduce the decay of skills and knowledge may include continuous maintenance of competency programs that employ
frequent short-duration interactions with content and skills after an initial course, or they may include guided
debriefings after real-life events that focus on response
improvement.
Debriefing is a learner-focused, nonthreatening technique to assist
individual rescuers or teams to reflect on, and improve,
performance. In manikin-based studies, debriefing as part of the
learning strategy resulted in improved performance in
post-debriefing simulated scenarios, and it improved adherence to
resuscitation guidelines in clinical settings.
Debriefing as a technique to facilitate learning should be included in all
advanced life support courses (ClassI, LOE B).
Our Definition!
A provider‐centric process designed to standardize the debriefing process to assist
clinicians in thinking about what they did, how they did it, and how
they can improve.
Structured and Supported Debriefing
A provider-centered approach
emphasizes self-discovery and self-critique.
A provider-centeredapproach also draws upon professional experience
andmotivation to perform well to enhance performance
and outcomes.
Thoughtful discussion after an attempted resuscitation is important to facilitate the sorting out of events
as well as gaining insight on what happened and why
We often learn better through self‐discovery
and self‐analysis than by other methods!
PROVIDERS NEED TO EXPRESS
THEMSELVES AND THEIR FEELINGS…
AND THIS IS A GREAT FORUM FOR
THAT!
•Have long term view•Patients and patience•INSTANT GRATIFICATION!
IMPLEMENTATION
Supported elements include both interpersonal support as well as use of protocols, algorithms, and
best evidence to inform debriefing statements/questions.
Structured and Supported Debriefing
Team leader trained in Structured
and Supported Debriefings
ROLE OF FACILITATOR
•PROVIDE SAFE ENVIRONMENT FOR SHARING EXPERIENCES
•DRAW OUT INFORMATION AND EXPERIENCES
•CONTENT DIRECTED BY THE CREW
•NEVER JUDGE!
Gather, Analyze, Summarize
Structured elements include three specific debriefing phases with related goals, actions, and
time estimates.
Structured and Supported Debriefing
USE UNTAPPEDDATA!
INSTRUMENTED MANIKINS
ANECDOTAL EVIDENCE NUMERICAL DATA
NOT PUNATIVE!
PIZZA DIPLOMACY!
BOY, I AM REALLY
LOOKING FORWARD TO
THE DEBRIEFING
ON THIS CASE!
PRACTICE MAKES PERFECT!
THROUGH TEAMWORK, TRAINING AND EDUCATION, STRETCH FOR EXCELLENCE!
Be the change you want to see in the world. -Ghandi
