Authors (including presenting author) :
Chan AKM, Lo CWY
Affiliation :
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital
Introduction :
Highly complex care takes place within operating theatres. Constantly changing team compositions, complex surgical procedures, high risk medications, and high patient turnover contribute to physical and psychological burden for operating theatre (OT) staff. Critical clinical events are not infrequent within OT. Critical cases require inter-professional collaboration to optimize decision-making during resuscitation. Debriefing is a facilitated discussion among team members about the clinical events, cognitive frames and logistical issues to improve and sustain future performance; as well as an emotional outlet for inter-professional teams who have undergone highly stressful resuscitations. Literature suggests that post-event debriefing may improve team performance, efficiency of work, and promote safety culture. Current quality improvement programs such as morbidity and mortality focus on clinical management and policy – there is lack of addressing teamwork and communication issues amongst interprofessional team members involved in the crises, nor is there managing of emotional and psychological aspects. “Debriefing of Critical Clinical Events in Operating Theatre (DOCE)” program was thus implemented in PWH, where experienced facilitators debrief interprofessional staff who have undergone critical events within OT.
Objectives :
1) Determine perceived needs and barriers of implementing debriefing after critical clinical events in OT 2) Assess the impact of a structured debriefing program after critical clinical events in OT on emotional well-being of clinical staff, inter-professional communication, self-perceived competence, and overall safety culture. 3) Identify clinical improvements after implementation.
Methodology :
Pre-intervention needs survey was distributed to all OT staff, including surgeons, anaesthetists, nurses and supporting staff. A 10-month post-interventional survey was carried out to assess the impact on staff’s self-perceived competence and overall safety culture. Improvement outcomes were also documented for analysis.
Result & Outcome :
12 debriefing sessions were held and data were analysed from pre- and post- debriefing surveys. Respondents in both surveys believed debriefing is an important process (p=0.77) and specific skills are required for facilitation (p=0.985). 83.2% (pre) and 75.6% (post) respondents thought the specialist anaesthetist in the critical event should be the facilitator, while significantly more thought that expert debriefers not involved in the resuscitation should facilitate (12.6% to 21.8%, p=0.05). Major obstacles are inadequate time, lack of trained facilitators, feeling criticized, and lack of administrative support. Post-implementation, respondents found themselves more competent (75.6%), and noted improvement in team morale (64.1%). However, emotional issues were inadequately addressed. There was overall improvement in safety culture after implementation – including information and knowledge sharing (76.6%), culture of speak up (82%), inter-professional communication (85.2%), and working atmosphere (61.7%).
