Episode 105 Hot Debrief

Post by Patricia Capone, OMS IV

What is a Debrief?

A psychologically safe environment where a team can constructively communicate about an event that was triggering to the whole team

Hot vs. Cold

• Hot debrief:
  • Ideally less than 10 minutes long and happens within a short interval of a critical incident
  • Pros:
    • Great for the ER because critical incidents happen on shift all the time
    • Everyone that was involved in the event is typically available to debrief a few minutes after the event
    • Improves team cohesion
  • Cons:
    • Can be hard to lead right after a significant event
    • Can be emotionally difficult for everyone involved because they haven’t had time to process on their own

• Cold debrief:
  • Typically days to weeks after a critical incident
  • Often includes people who were not directly involved with the critical incident, like administration and outside sources.
  • Pros:
    • Having additional people who were not present for the event can help to process the event through a different lens
    • Everyone involved has had some time away from the event to gain perspective.
  • Cons:
    • It may be difficult to get everyone that was involved together again days to weeks later
    • Everyone is removed from the situation for long enough that they may have forgotten some of the details.
    • Everyone may have suppressed some of the emotions that came with the event

 

Tips for Leading a Hot Debrief:

R-E-S-E-T:

• • R – Recognize the critical incident
  • E – Emotional self-awareness
    • This step is essential in leading a hot debrief!
  • S – Self debrief
  • E – Empathy towards others emotions
  • T – Team hot debrief:
    • Can be done in many different ways, but always helpful to follow a format
      • Ex: “STOP for 5 minutes”
        • S – Summarize the case
        • T – Talk about things that went well
        • O – Opportunities to improve
        • P – Points to follow up on
      • Be sure to focus on the emotional/human elements of the critical event, instead of the medical/technical elements
        • There will be time for this later

Set the rules:

• “We’re going to spend 5 minutes right now doing a debrief. The purpose is to improve the quality of patient care and our team dynamic.”
• “It is NOT for blaming or for personal feedback. This is a general feedback session.”
• “Participation is very welcome, but not mandatory.”
• “Everything said here is confidential.”

Be vulnerable and honest with your team

Keep practicing

Take time for a moment of silence if the critical event involves loss of life

• Don’t forget that that person was someone special to a lot of people.
• They deserve that time

Always thank the team

How to make it part of your practice:

• Start by building more emotional self-awareness
• End of shift check-ins
• Try to incorporate it more in real-time while on shift
• Most helpful thing in actually implementing this is having a script

 

 

About Our Guests:

Megan Gillespie, DO is a graduating Chief Resident of the combined Emergency Medicine/Family Medicine program at Jefferson Health Northeast in Philadelphia, PA. After graduation, she will be working in the ED at the Hospital of University of Pennsylvania. She went to Lake Erie College of Osteopathic Medicine and was a Mentee in CORD’s Mini-Fellowship in Wellness Leadership. This past year she decided to focus on hot debriefing as her longitudinal project for this Mini-Fellowship.

 

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References:

1. YouTube presentation of R.E.S.E.T. Hot Debriefing Curriculum: https://www.youtube.com/watch?v=Av7otOmr7tA
2. Goleman D. Emotional Intelligence: Why It Can Matter More than IQ. 10th Anniversary Edition. New York City, NY: Bantam Books; 2006. Available for purchase at https://bookshop.org/.
3. Mitchell JT, Dyregrov A. Traumatic stress in disaster workers and emergency personnel. In: Wilson JP, Raphael B (eds). International Handbook of Traumatic Stress Syndromes. The Plenum Series on Stress and Coping.Boston, MA: Springer; 1993:905-914. https://doi.org/10.1007/978-1-4615-2820-3_76. Accessed August 13, 2020.
4. https://pubmed.ncbi.nlm.nih.gov/33440103/ (Walker CA, McGregor L, Taylor C, Robinson S. STOP5: a hot debrief model for resuscitation cases in the emergency department. Clin Exp Emerg Med. 2020; 7(4):259-266. doi: 10.15441/ceem.19.086)
5. Alavarez A, Kleven J, Little A. Humanism in Death. EP Monthly https://epmonthly.com/article/humanism-in-death/