Modified debriefing tool successfully identifies opportunities for performance improvement in a multidisciplinary ED

Clinical researchers at Johns Hopkins Hospital in Baltimore, Maryland, developed and tested a modified version of the Team Strategies and Tips to Enhance Performance and Patient Safety (TeamSTEPPS) debriefing tool in a multidisciplinary urban emergency department (ED). They found that the tool was helpful in identifying safety threats and opportunities for performance improvement.

The aim of this pilot study was to create and test a tool that could capture latent safety threats and help leaders working in ED settings better understand their clinical environment. Previous studies have shown that structured debriefing following a critical care event contributes to increased communication and improved patient outcomes. However, post-event debriefing only occurs 25% of the time in the ED setting, according to a 2015 study published in the Annals of Emergency Medicine.

The TeamSTEPPS model for healthcare providers, developed by the Agency for Healthcare Research and Quality and the Department of Defense Team, relies on a structured debriefing tool to operationalize situational awareness, communication, and teamwork. For this study, researchers modified the debriefing tool for use in the ED and evaluated its use by healthcare teams working in an urban ED, following critical care services administered between April and September 2017.

Prior to the study’s implementation, participants went through TeamSTEPPS training to learn the elements of the model. Participating team members were asked to consistently complete a one-page form immediately following critical care events to facilitate standardized debriefing. A designated team leader would summarize responses, highlight areas for improvement, and provide peer support based on documented responses.

Reported data was later collected and qualitatively coded by two independent reviewers to identify overall themes related to what went well, what didn’t go well, and what the teams think they need to improve on. The reviewers highlighted the following frequently occurring themes mentioned by team members: leadership, teamwork, noise, built space, equipment, clinical care, and other.

Based on 30 debrief forms from team members, the reviewers determined that most negative comments pertained to the following:

• Equipment issues (24% of negative comments)
• Noise levels (20% of negative comments)
• Clinical care (15% of negative comments)

The reviewers determined that most positive comments pertained to the following:

• Noise (45% of positive comments)
• Teamwork (30% of positive comments)
• Clinical care (15% of positive comments)

Participants most frequently noted that noise, equipment, and clinical care were areas that needed improvement. Notably, what was a strength to one team was often a deficit to another. 

Researchers concluded that the TeamSTEPPS training and modified debriefing tool allowed staff to effectively capture actionable feedback. They encourage other healthcare teams to replicate or modify their process to create evidenced-based standardized debriefing tools that can improve team performance and patient outcomes.