Debriefing medical teams: 12 evidence-based best practices and tips.

BACKGROUND Medical teams are commonly called on to perform complex tasks, and when those tasks involve saving the lives of critically injured patients, it is imperative that teams perform optimally. Yet, medical care settings do not always lend themselves to efficient teamwork. The human factors and occupational sciences literatures concerning the optimization of team performance suggest the usefulness of a debriefing process--either for critical incidents or recurring events. Although the debrief meeting is often used in the context of training medical teams, it is also useful as a continuous learning tool throughout the life of the team. WHAT ARE GOOD DEBRIEFS? AN OVERVIEW The debriefing process allows individuals to discuss individual and team-level performance, identify errors made, and develop a plan to improve their next performance. BEST PRACTICES AND TIPS FOR DEBRIEFING TEAMS THE DEBRIEF PROCESS: The list of 12 best practices and tips--4 for hospital leaders and the remainder for debrief facilitators or team leaders--should be useful for teams performing in various high-risk areas, including operating rooms, intensive care units, and emergency departments. The best practices and tips should help teams to identify weak areas of teamwork and develop new strategies to improve teamwork competencies. Moreover, they include practices that support both regular, recurring debriefs and critical-incident debriefings. Team members should follow these main guidelines--also provided in checklist form--which include ensuring that the organization creates a supportive learning environment for debriefs (concentrating on a few critical performance issues), providing feedback to all team members, and recording conclusions made and goals set during the debrief to facilitate future feedback.

[1]  Robert L. Helmreich,et al.  Team performance in the operating room. , 1994 .

[2]  J. Mathieu,et al.  Toward Theoretically Based Principles of Training Effectiveness: A Model and Initial Empirical Investigation , 1995 .

[3]  E. Salas,et al.  Guidelines for use in team-training development. , 1992 .

[4]  J. Tu,et al.  Problems for clinical judgement: 3. Thinking clearly in an emergency. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[5]  Michael J. Kavanagh,et al.  Applying Trained Skills on the Job: The Importance of the Work Environment , 1995 .

[6]  Eduardo Salas,et al.  Special Section Commentary: Opportunities and Challenges for Human Factors and Ergonomics in Enhancing Patient Safety , 2006, Hum. Factors.

[7]  R. Key Dismukes,et al.  Facilitation and Debriefing in Aviation Training and Operations , 2000 .

[8]  M. Makary,et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. , 2006, Journal of the American College of Surgeons.

[9]  E. Salas,et al.  A FRAMEWORK FOR UNDERSTANDING PRE‐PRACTICE CONDITIONS AND THEIR IMPACT ON LEARNING , 1998 .

[10]  Richard Lepsinger,et al.  Flexible Leadership: Creating Value by Balancing Multiple Challenges and Choices , 2004 .

[11]  J. Mathieu,et al.  The influence of shared mental models on team process and performance. , 2000, The Journal of applied psychology.

[12]  R J Lilford,et al.  The measurement of active errors: methodological issues , 2003, Quality & safety in health care.

[13]  D. Gaba,et al.  Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. , 1992, Aviation, space, and environmental medicine.

[14]  J. Mathieu,et al.  Performance implications of leader briefings and team-interaction training for team adaptation to novel environments. , 2000, The Journal of applied psychology.

[15]  C. Burke,et al.  The impact of cross-training on team effectiveness. , 2002, The Journal of applied psychology.

[16]  R. Helmreich,et al.  Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences , 1998 .

[17]  E. Salas,et al.  Individual and team decision making under stress: Theoretical underpinnings. , 1998 .

[18]  J. Cooper,et al.  An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. , 1984 .

[19]  Robert Simon,et al.  Debriefing with good judgment: combining rigorous feedback with genuine inquiry. , 2007, Anesthesiology clinics.

[20]  E. Salas,et al.  Promoting health care safety through training high reliability teams , 2005, Quality and Safety in Health Care.

[21]  Irwin L. Goldstein,et al.  Training in organizations: Needs assessment, development, and evaluation , 1986 .

[22]  S. Kozlowski,et al.  Work Groups and Teams in Organizations , 2003 .

[23]  R H Brook,et al.  Can health care quality indicators be transferred between countries? , 2003, Quality & safety in health care.

[24]  P. Warr,et al.  TRAINEE CHARACTERISTICS AND THE OUTCOMES OF OPEN LEARNING , 1995 .

[25]  John P. Campbell,et al.  Individual and team training. , 2002 .