Debriefing After Critical Events Combines Review, Reflection

Newswise — A tailored debriefing process at an Illinois children’s hospital provided additional support to staff following critical patient events and contributed to increased levels of compassion satisfaction a year after implementation.

Members of the bereavement/wellness committee in the pediatric intensive care unit (PICU) at Ann & Robert H. Lurie Children’s Hospital of Chicago developed the Rapid Review of Resuscitation (R3) debriefing process to allow time for reflection and communication following critical patient events. One year after implementation, staff compassion fatigue scores improved significantly, while levels of burnout and secondary traumatic stress were the same as before implementation.

“Debriefing After Critical Events Is Feasible and Associated With Increased Compassion Satisfaction in the Pediatric Intensive Care Unit” is published in the June issue of Critical Care Nurse (CCN).

The 40-bed, high-acuity, high-volume PICU is one of three ICUs at the hospital, which supports seven inpatient care units and 70 pediatric subspecialties.

“Many debriefing processes focus on communication and teamwork but neglect the emotional impact of critical patient events. We specifically added elements to reflect, to honor the patient’s life and recognize the team’s efforts,” said co-author Courtney Nerovich, BSN, RN, a nurse in the PICU and a member of the committee. “These additions may have enhanced clinician, patient and team connections while supporting mindfulness and reflection.”

Before the R3 implementation, the standard practice was to hold a debriefing several days to weeks after a traumatic event. The process was inconsistent and often had poor attendance.

After a literature review and several individual staff interviews, the team created a single-page debriefing guide with scripted language and open-ended questions. The guide included three essential process components that aligned with staff needs: a review of the patient event and team dynamics, acknowledgement of the event’s emotional impact on staff, and (for events in which the patient died) a moment of reverence to honor the patient’s life.

Feedback led to minor adjustments to the initial debriefing process, including development of a guide specific to the planned withdrawal of life-sustaining therapies named R3-D. 

Selected charge nurses, fellows, attending physicians and PICU managers agreed to serve as R3 champions to pilot and initiate the debriefing process using the R3 and R3-D guides. A one-hour orientation introduced them to the guides and included demonstrating the process, role-playing and holding an open forum for questions.

The R3 process was designed as a hot debriefing to be completed voluntarily before the end of the shift. The expectation was that after a critical patient event, an R3 champion would contact the primary medical team and determine a time to conduct a debriefing during the current shift, if possible.

When the debriefing was scheduled, the champion would notify all staff members who were directly or peripherally involved in the event, with the goal of including as many of them as possible. During the debriefing, the champion read the guide and recorded the team’s responses.

Completed forms from debriefings were kept in a secure area in the PICU management office and reviewed by the initiative’s interdisciplinary team to identify areas for potential improvement in the process. Among the findings, the analysis revealed that the forms were more commonly completed after a patient’s death, and not after every critical event.

During this same time frame, the R3 debriefing process was one of multiple efforts aimed at increasing staff wellness and reducing burnout, and the results may reflect the impact of the bundle of interventions rather than the debriefing process alone.

In the 12 months after implementation of the new process, the debriefings were integrated into the PICU culture and became expected and valued by staff. It has since been implemented on other inpatient care units and has received overwhelmingly positive feedback.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 128,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and over 190 chapters in the United States.

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