S.T.O.P. for 5 minutes: A bespoke "Hot Debrief" tool for resuscitation cases in a tertiary centre emergency department
Title:
S.T.O.P. for 5 minutes:
A Bespoke Hot Debrief Tool for Resuscitation Cases in a Tertiary Centre Emergency Department
Background:
Hot Debriefs are interactive structured team dialogues that typically occur immediately following complex clinical cases. A foundational behaviour of high performing excellent teams, they are designed to optimise learning from clinical experience, to encourage reflection, identify team strengths and challenges, and to focus on ways to improve future performance.
Team-based Resuscitation Care in Emergency Departments (EDs) appears an excellent opportunity for Hot Debriefs. Surprisingly, the authors were unable to identify examples of EDs performing regular, structured, effective Hot Debriefs. For our Tertiary Care ED, we sought to identify target patient groups, potential benefits, challenges and barriers to implementation, and to create an effective bespoke Hot Debrief Tool.
Methods:
All ED staff at the Royal Infirmary of Edinburgh were invited to attend a Hot Debrief Study Day to determine whether development of a bespoke debriefing tool was feasible. Existing debriefing frameworks from research literature were distributed as pre-course reading (1,2,3,4). Together, we reviewed existing models, identified potential benefits and foreseen barriers then created a new Hot Debrief framework. We tested and adapted further using footage of simulated complex resuscitation cases.
Results:
Study day attended by 7 EM Consultants, 3 Senior Staff Nurses and 4 EM Registrars. Potential benefits identified: improving staff morale, team cohesion and care for future patients. Postulated use would promote culture for learning, safety and quality improvement. Overwhelmingly, time pressure was identified as most frequently foreseen barrier followed by team dispersal and competing interests of clinical priorities (other Resus patients/tasks in ED). Psychological safety and performance anxiety were identified as potential barriers for all participants.
There was unanimous agreement to develop/pilot bespoke Hot Debriefing tool. Entitled “STOP for 5 Minutes”, it emphasises short time allocation required. Resuscitation cases targeted: “Medic One” call-outs (pre-hospital retrieval), major trauma, cardiac arrests, deaths in Resus and any staff-triggered requests.
Framework detail:
Introduction: Debriefing Lead thanks team and asks “Is everyone okay?”
If case meets selection criteria then continue, stating “We are now going to have a 5-minute team debrief. The purpose of the debrief is to improve the quality of patient care; it is not a blaming session. Your participation is welcomed but not compulsory. All information discussed during this debrief is confidential.”
S: Summarise the case (any team member)
T: Things that went well
O: Opportunities to improve
P: Points to action and responsibilities (staff members to action each point).
STOP Framework posters displayed clearly in all Resuscitation Rooms. Accompanying data collection form developed including all sections, reasoning if/why eligible Hot Debriefs not performed and if Cold Debrief required. Format publicised throughout ED and staff handovers. Currently auditing use and progress.
Conclusions:
We identified potential benefits, challenges and target patient groups for Hot Debriefs within our ED and used these to develop a short, effective Hot Debrief framework within Tertiary Centre ED. We anticipate this tool to be globally generalizable and effective for many high-performing excellent ED teams worldwide.
