Action After Debrief

After Action Debrief:

The following debrief format is a guide for medically debriefing fast-paced events.  This is not a bereavment debrief.  The recommendations here are based on JHACO recommendations found in "Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips”, Salas et al.

Instructions for Senior

A. When to use?

●After CATs and Code's

●As soon as possible after event (preferably within 1 hour)

B. Who should attend?

●Intern, Involved Seniors

●Fellows, charge nurse, nurses, RT's, attending (PICU or PHAST) may add value if available, but should not delay debriefing.

Before Debriefing - senior should:

i.Identify a Goal for Debrief. - Ex: Make team better?  Find out what went wrong?  Clarify treatment choices?  Validate clinical decisions?

ii.Identify Key Performance Measures - exceptionally good or bad behaviors.

iii.Set a Time and Place. 

iv.Notify interested parties

v.Circle up and Sit.

Debrief Structure and Prompts

1."Can a volunteer briefly recap what happened?”

○Goal is to remind and start to reconstruct the event.

2."What stands out to you about this event?”

○Identify/Discuss your Key Performance Measures (exceptionally good behavior or potentially harmful behaviors)

○Discuss actual or potential impacts of those behaviors - "How does that behavior affect the patient?  The team?”

○Offer/discuss solutions - "How can we fix that?”

3."How did we do as a team?”

○Discuss team performance: Focus on PROCESS more than OUTCOME. 

i.Planning - Did we have a shared mental model among all team members?

ii.Situational Awareness - Were status changes reported accurately and on-time?  Did the team adapt well to a changing situation?

iii.Supporting Behavior- Was senior oversight adequate, timely, and effective?

iv.Communication - Was 2-way and closed loop communication used?

v.Leadership - Did we know who was in charge?  Did they control the event well?

4."How do you think you did?”

○"Did you feel like your role was clear?”

○"What was something you did that you would like to do again?”

○"What do you want to do differently?”

5.Conclusion - "Any lingering questions?”, "What will you take away from the experience?”