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Title of Journal: Intensive Care Med

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Abbravation: Intensive Care Medicine

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Springer Berlin Heidelberg

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DOI

10.1002/chin.199030044

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1432-1238

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Debriefing to improve outcomes from critical illne

Authors: Keith Couper Bilal Salman Jasmeet Soar Judith Finn Gavin D Perkins
Publish Date: 2013/06/11
Volume: 39, Issue: 9, Pages: 1513-1523
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Abstract

Intensive care clinicians play a central role in the coordination and treatment of patients that develop lifethreatening emergencies This review evaluates the effect of debriefing after lifethreatening emergencies and considers the implications for intensive care training and practiceStudies were identified by searching electronic databases citation tracking and contact with subject specialists Studies evaluating the effect of debriefing after lifethreatening emergencies on clinician performance process and/or patient outcomes were eligible for inclusion Study quality was assessed and summarised using the GRADE systemThe search identified 2720 studies After detailed review 27 studies were included of which 20 supported the use of debriefing Debriefing was viewed positively n = 3 improved learning n = 1 enhanced nontechnical performance n = 4 and technical performance n = 16 and improved patient outcomes n = 2 Four cardiac arrest studies were suitable for metaanalysis This found evidence of improved resuscitation process outcomes compression fraction mean difference 680 95  CI 419–940 p  0001 and shortterm patient outcome return of spontaneous circulation OR 146 95  CI 101–213 p = 005 There was no effect on survival to hospital discharge OR 080 95  CI 038–167 p = 055This review supports the use of structured debriefing as an educational strategy to improve clinician knowledge and skill acquisition and implementation of those skills in practice However the effect of debriefing on longterm patient outcomes is uncertain There remains a need for further highquality research which seeks to identify the optimal method for debriefing delivery and effect on patient outcomesWe gratefully acknowledge Professor Simon Gates for reviewing the statistical methods in this paper and Chharitha Veerapaneni for assistance with the data abstraction process Neither Professor Gates nor Miss Veerapaneni received any compensation KC is supported by a Resuscitation Council UK Research Fellowship GDP is supported by the Intensive Care FoundationKC European Resuscitation Council travel/accommodation JS ILCOR Advanced Life Support Task Force CoChair voluntary Editor of the journal Resuscitation paid European Resuscitation Council and American Heart Association travel/accommodation JF ILCOR Education Implementation and Teams Task Force CoChair voluntary American Heart Association travel/accommodation and Director of the Australian Resuscitation Outcomes Consortium AusROC for which she receives partial salary support GDP ILCOR Advanced Life Support Task Force CoChair voluntary NIHR Research for Patient Benefit Programme Grant part funds salary Editor of the journal Resuscitation paid European Resuscitation Council American Heart Association and Resuscitation Council UK travel and accommodation BS has no conflicts of interest KC had full access to all of the data in the study and takes full responsibility for the integrity of the data and accuracy of the data analysis

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