Debrief in a clinical context refers to conversational learning between clinicians involved in patient care, that most commonly occur after a difficult event. This will most commonly be after a death in the department but may also be required after a difficult resuscitation, patient deterioration or an episode of conflict or challenging behaviour of any kind. Clinical debriefing aims to provide an opportunity for improvement, reflection and learning for individuals and teams. It is for teams to come together in a safe environment to collectively understand and process often complex and challenging situations and provide the opportunity to share different experiences and perspectives of the same event. Debriefs are reflective processes for individuals and teams.
Debriefs are not interrogations of clinical cases and should not be used as an investigation or case review. They are not about attributing blame and the psychological safety of all those involved is paramount. Everyone involved should be given the opportunity to attend a debrief, but attendance is not compulsory. Team members should be able to explore questions and uncertainty about the clinical scenario and be able to seek clarification about elements they did not understand.
All debriefs should be managed in a safe and supportive way. Leading a debrief after you have been involved in a challenging event can be difficult. Remembering all the elements required to ensure the process is psychologically safe for all involved is difficult to do but essential for the welfare of those involved. The approach to a debrief should be carefully considered and standardised to minimise further trauma to any individuals present. Any debrief process should be structured and chaired, and must include a process to identify the need for on-going support for any staff members involved and signpost to these services. The debrief must set expectations of anticipated normal reactions following an upsetting or stressful event as well as immediate signposting for additional psychological support to all those involved. This may be in the form of TRiM referrals or equivalent, access to formal psychology support and other organisational resources. Our recommendation is that every trust should have a structured support system with a dedicated Emergency Department lead to support robust processes and oversight of debrief and additional psychological resources.
Hot Debriefs usually occur soon after a challenging event, ideally involving all the staff who were involved. The aim of a Hot Debrief is to ensure a shared understanding of the sequence of events or narrative among all the individuals involved and to ensure that any immediate concerns with any parts of the process can be addressed immediately. This may include personnel, equipment or process issues.
Cold debriefs are not required in every situation, but may need to be considered for more complex or challenging cases, or those where many questions are left unanswered. The aim of the cold debrief is to bring a team together to provide some closure to an event and answer or address any uncertainties from the initial event. This might include a death where the cause of death was unknown and a cold debrief is held after post mortem results, or a series of challenging interactions leading to distress among a staff group for example. The debrief tools, created with psychology support and approval, aim to assist with the planning and running of clinical debriefs. They aim to support the individual leading the debrief and also to standardise the approach to and structure of a debrief, thus ensuring appropriate psychological safety for all those involved. The tools ensure that all important aspects of a debrief event are considered and that action or learning points are appropriately recorded for further shared learning or addressing.