Crisis checklist for critical event debriefings: Findings from a mixed-methods study

Abstract

BackgroundPerioperative critical events (e.g., anaphylaxis, cardiac arrest) are common life-threatening emergencies across health systems but may be infrequent at the level of the individual clinician. Proximal debriefing shortly after such events has been promoted in the medical literature and via simulation, however the gap between principle and practice is poorly understood. We sought to study the patterns and components of these debriefs based on real-life events. MethodsIn this observational mixed-methods study, anesthesia providers in perioperative care areas and intensive care units from an academic medical center who recently experienced a perioperative critical event were queried regarding patterns of critical event debriefing and invited to participate in a semi-structured interview. We measured the types and location of critical events, rate of debriefing, and supporting themes surrounding the event. ResultsOver a six-month period, 81 critical events were queried, of which 28 (35 %) were debriefed. Common events included significant/prolonged hypotension and/or hypoxemia (33 %), cardiac arrest (27 %), and massive hemorrhage (21 %). Common event locations included operating room (70 %), nonoperating room anesthesia (10 %), and intensive care unit (7 %). Of the events queried, 51 events had a semi-structured interview. The themes for an ideal debriefing aligned with the themes of performing a Welfare check, assessing Acute corrections, soliciting Team reactions, allowing for medical Education, and providing supportive Resources. ConclusionOne-third of perioperative critical events were proximally debriefed. Themes from involved anesthesiology personnel revealed desirable components of a practical and brief real-time proximal debriefing. A checklist encompassing a review of the literature, multidisciplinary expertise, and lessons from this mixed-methods work has the potential to improve the quantity and quality of debriefing that is often absent in the aftermath of a perioperative critical event.