7 Reasons to Debrief for Every Patient, Every Time

How does your team make time to debrief?

This critical communication immediately following a surgical procedure provides a window of time for team connection to confirm important information about the events of the procedure and to address any needed improvements.

For many teams, the debriefing is one element of the surgical safety checklist that proves difficult to standardize.

“This is a busy time in the OR as the surgeon is completing the surgery, the final count is being performed, the surgical techs are assembling the surgical instruments for decontam, the patient is waking up, and the periop team is preparing to turn the room for the next case,” shares Kristy Simmons, MSN, RN, CNOR, a perioperative nurse at Woman’s Hospital in Baton Rouge, La. who also serves on AORN’s board of directors.

Understanding Debriefing Challenges

Caring for mainly pediatric and OB/GYN patients, Simmons explains that many surgeries change from the original plan shared before the case and during the Time Out.

Any changes from the initial surgical plan need to be discussed immediately after the procedure to confirm appropriate postoperative treatment such as wound care, pain relief and antibiotic administration—a plan that must be established in the OR so it can be clearly shared in the handoff to the PACU nurse, she explains.

“Sometimes nurses may end up having to call the surgeon after a case if the surgeon leaves the room for an emergency case prior to a proper debriefing process,” she shares. “While it's good to verify this information, it's not as good as being able to debrief as a team face-to-face to discuss the exact surgical procedure performed and any specific patient concerns.”

Simmons is leading a debriefing improvement initiative at her hospital to understand the barriers preventing a more standardized face-to-face debriefing process. Here are some of their recognized barriers: 

• Pressure to turn the room
• End of case responsibilities that require individual attention
• Physicians having to leave the OR for another emergency case prior to team debriefing
• Case variations that require tailored discussion for the handoff

Discussing Why the Debrief Needs to Happen for Every Patient, Every Time

The debrief occurs during Sign-Out, the fourth communication episode of AORN’s Comprehensive Surgical Checklist. It is designed for OR teams to tailor it for specific needs.

A standardized debriefing process is also recommended in AORN’s Guideline for Team Communication as a critical episode to:

• improve teamwork and team communication,
• foster continuous team learning, and
• improve the quality of patient care by identifying defects or system barriers in care and allowing teams to learn from those defects.

Evidence is always the best basis for discussing improvements to practice.

Here are 7 evidence-based reasons from the guideline to support a standardized debriefing for every patient, every time:  

1. The debriefing process can cover a range of critical patient care elements such as: confirmed count, blood loss, pain management, and VTE prophylaxis.
2. It gives team members a chance to identify improvements in efficiency and patient safety, as well as any defects in care.
3. It provides an opportunity for all team members to confirm and discuss the plan for patient care transition from the OR to another team.
4. Input from individual team members during the debriefing helps to identify care relevant to specific patient populations.
5. Focused questions during the debriefing that are tailored to the procedure can make the process more sustainable.
6. The debriefing can be more effective when unnecessary activities and conversations in the OR or procedure room come to a stop.
7. The debriefing can become more standardized and consistent with the use of a checklist to guide the discussion.

FREE RESOURCES FOR MEMBERS

Plan to strengthen your team’s communications by promoting Time Out awareness in your facility with these ideas from AORN.

Guideline Essentials: Access your implementation tools for team communication.

• Quick Views: Quick, instructional video shorts and simple implementation steps
• Case Studies: Real-life examples that emphasize the importance of following the guideline
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements

Tool Kits

AORN Comprehensive Surgical Checklist

Creating a Practice Environment of Safety

Clinical FAQs

Team Communication