Kootenai Health offers a comprehensive set of resources for our employees aimed at helping to process the hardships they see as part of their job. Whether you are a front-line patient care team member or a supporting team member in any department, you are a caregiver. Every Kootenai Health employee can impact the patient experience and in turn be impacted by their own experiences working in healthcare. Caring for those who are sick and injured takes a toll and we understand that our caregivers are a precious resource for our community. We encourage anyone who is struggling to use the tools offered throughout our Caregiver Well-Being pages, as well as those below that are specific to dealing with stressful events.

DEBRIEFING

What is a post-event debrief?

“Facilitated discussion of actions and thought processes after an event to promote reflective learning and improve clinical performance.”

Essential elements include:

• Active learning
• A primary intent for improvement
• Reflection on specific events (not general performance)
• Inclusion of input from multiple team members

Support for Performing Post-Event Debriefs

• Helps team members process emotionally
• Improves individual and team performance
• Key to long-term sustainable improvements
• 2013 meta-analysis found that organizations can improve individual and team performance by up to 25% by conducting effective debriefings2
• Post event debriefings have been shown to increase overall performance, reduce frequency of equipment related problems, and improve communication and teamwork3-6
• American Heart Association (AHA) endorses debriefing as a strategy to improve cardiopulmonary resuscitation quality

Example:

View a video demonstration of a debriefing here.

Barriers to Debriefing

If debriefing is a positive and useful tool, why don’t we do it more often and consistently? Some possible barriers your team might find are:

• Barrier: Insufficient time
• Suggested Solution: Limit debriefings to < 10 min, use a structured approach to keep conversation on track, hold systems issues not immediately solvable for later discussion with leadership
• Barrier: Lack of skilled facilitators
• Suggested Solution: Share the information from this site with your team at team huddles, department meetings, and education sessions.  Give staff the opportunity to practice debriefing.
• Barrier: Lack of appropriate setting
• Suggested Solution: Identify designated areas/rooms for confidential conversations, hold debriefs in those areas

How to Debrief

General Guidelines

• As many members involved in the event as possible should participate
• Identify a private location to hold the debrief
• One individual should lead or facilitate the debrief
  • Provider if involved in event
  • Other lead clinician if no provider involved
• Debrief triggers12:
  • Death
  • Code Blue or Rapid Response
  • Significant procedures
  • Safety events (near miss, patient harm)
  • Interpersonal events

Kootenai Health Tools for Debriefing
If you are unfamiliar with debriefing or need a prompt as you lead a debriefing, review the links below.

• Debriefing Template
• Debriefing Form

The template includes a structure for leading the conversation as well as some sample wording.  The form can help capture takeaways from the debriefing, but is not required.

Examples

• https://www.youtube.com/watch?v=bDOK8JQesSE&feature=emb_logo
• https://www.youtube.com/watch?v=4jB6ISx0SFc
• View a video demonstration of a debriefing here.

Helpful Phrases for a Debriefing

Topic	Helpful Phrases
Creating psychological safety	“Our goal is to improve how we work together and care for our patients.” “As a team, we want to understand how we can support the best performance.”
Open-Ended Questions and Discussion	“What aspects of the event do you think were managed well?” “How can we do better next time?” “I was concerned/worried…” “How do you see it?” “What were your thoughts at the time?” “What strategies do you see that would be helpful going forward?” “I noticed ______.  Next time you may want to ________, because _________.”
Summary	“What are the key take-aways from our discussion?” “The key points for this case are…” “What issues, if any, do we need to spend more time on?”

Behavioral Skills Relevant to Patient Events

It can be helpful to discuss behavioral skills with each debrief, especially as debriefing is normalized in your area.  Below is a list of skills contributing to successful outcomes that it may be helpful to address.

Anticipation and Planning	Clear role definition	Communication
Constructive intervention	Decision making	Delegation
Knowing one’s limitations	Knowledge sharing	Leadership
Mutual respect	Situational awareness

CRITICAL INCIDENT STRESS MANAGEMENT (CISM)

Critical Incident Stress Management, or CISM, is an intervention protocol developed specifically for dealing with traumatic events. It is a formal, highly structured and professionally recognized process for helping those involved in a critical incident to share their experiences, vent emotions, learn about stress reactions and symptoms and given referral for further help if required. CISM includes a number of interventions, including debriefing and defusing. The Kootenai Health CISM Team provides both formal debriefings and more informal gatherings for staff, as well as defusings, which occur prior to end of shift following a traumatic or difficult situation.

CISM debriefings and defusings, both formal and informal are for groups.

Request a CISM debriefing or defusing if your team has experienced a traumatic patient-related situation such as an unexpected or difficult death or trauma, a challenging patient or family situation, or when there has been an accumulation of difficult events, whether patient-related or non-patient-related.

Contact your director supervisor to make a request from Jennifer James, Manager of Chaplain Services.

What’s the difference between a CISM defusing and the immediate debriefs led by the caregivers involved in an event?

	CISM Defusing*	Caregiver-Led Immediate Debriefs
Who leads?	A Kootenai Health CISM team member certified by ICISF	Ideally, the senior clinician involved in the event, but it could be led by anyone involved in the event
Who attends?	Anyone involved in the event, even if just working nearby	Anyone directly involved in the event
When is it?	Ideally before the end of shift	Ideally before the end of shift
Focus	Psycho-social emotional impact of an event and lessening of the effects	What went well and what could be improved from the recent event
Process Improvement	CISM does not focus on process improvement	Designed to increase learning, identify improvements
Emotional Care	CISM is focused on providing an emotional check-in and care	This may or may not be a part of the debrief depending on the situation

*NOTE: CISM Debriefings are held 24-48 hrs following a traumatic or challenging event. They follow an established sequence/organization and, like defusings, are focused on the psycho-social-emotional impact of the event or situation rather that process improvement.