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The Benefits of Debriefing after Critical Incidents in Anesthesia

By September 20, 2019 No Comments

Research shows that debriefing, or rehashing the details, after incidents that are psychologically and physically taxing can aid in the prevention of post-traumatic stress disorder (PTSD).1 In particular, critical incident stress debriefing (CISD)—defined as a small-group, supportive crisis intervention serving as “psychological first-aid”—aims to mitigate the impact of a traumatic event, facilitate normal recovery and screen people who may benefit from professional support services.2 CISD strategies can be applied to critical incidents that occur in the medical profession, particularly in specialties involving emergency care. Critical incident reporting can also be used in medical education to encourage students’ professional development and to address their values and attitudes in the context of their new profession.3 Overall, debriefing after critical incidents is widely applicable across the medical field.

Critical incident debriefing differs in structure across various contexts. CISD, as a highly structured version of debriefing after critical incidents, involves seven clearly defined phases.2 CISD serves as an example of a standardized practice in critical incident debriefing that may be applied to less formal contexts, many of which do not have standard protocols. For instance, one study of pediatric emergency departments (EDs) showed that 70 percent of participants did not have a hospital protocol on debriefing,4 and another found that only 18 percent of responders’ debriefing sessions had been led by specifically trained personnel.5 As researchers have expressed, critical incident debriefing varies across individuals, and more consistent practice and education may be pertinent to its use in health care.4-6

Because data on critical incident debriefing are mixed, however, it can be difficult to establish a standard protocol. In a non-health care context, Campfield and Hills found that immediate debriefing was preferable to delayed debriefing for reduction of post-traumatic stress symptoms.7 Yet it is unclear if these results would replicate for health care professionals, as Ireland et al.’s article on debriefing in pediatric departments expresses that “cold debriefing”—i.e., debriefing after some time has passed, instead of immediately—is associated with improvements in process and patient outcomes.5 In Theophilos et al.’s study on pediatric emergency departments, half of the debriefings occurred within 24 hours of the critical incident, but some occurred up to a week after, making it challenging to analyze the efficacy of debriefing.4 Additionally, Mitchell et al.’s review of meta-analyses on critical incident debriefing showed that it can decrease recovery time and alleviate effects on an individual’s relationships, but that—according to some studies—it does not always have positive results and could even potentially cause harm.8 Mitchell et al. explain these discrepancies in the efficacy of debriefing through potential alterations in support systems, differing interpretations of interventions and ineffective use of processes. Given these authors’ various findings, it is crucial that future research focus on the optimization and standardization of debriefing processes.

Though a standard debriefing protocol has yet to be established, several studies show that debriefing is positively rated by health professionals. Tan found that among anesthetic trainees, almost half of respondents did not feel supported by their department after a negative outcome incident, but that those who had debriefings were more likely to feel supported by senior colleagues.6 Theophilos et al.’s study on the pediatric emergency department also highlighted health professionals’ opinions on debriefing, showing that they ranked the most commonly debriefed topics—death of a patient, multi-trauma and sudden infant death syndrome (SIDS)—also as highest in importance for debriefing. Furthermore, debriefing was rated as very important by professionals, with doctors giving it eight on a ten-point scale and nurses giving it ten.4 Overall, health care workers in these studies appeared to find debriefing beneficial.

Taken as a whole, the information on critical incident debriefing shows that it is widely used and applicable in various health care settings, and is often supported by health professionals. Several researchers stress the importance of standardizing debriefing practices, as its beneficial effects for reducing post-traumatic stress can vary depending on its use. Future studies should focus on the best structures for debriefing among health professionals, as well as ways to broadly implement debriefing protocols across hospitals and health centers.

1.         Mitchell JT, Everly GS. Critical Incident Stress Debriefing (CISD) and the Prevention of Work-Related Traumatic Stress among High Risk Occupational Groups. In: Everly GS, Lating JM, eds. Psychotraumatology: Key Papers and Core Concepts in Post-Traumatic Stress. Boston, MA: Springer US; 1995:267–280.

2.         Mitchell JT, Everly GS. Critical incident stress management and critical incident stress debriefings: Evolutions, effects and outcomes. In: Raphael B, Wilson J, eds. Psychological Debriefing: Theory, Practice and Evidence. Cambridge, UK: Cambridge University Press; 2000.

3.         Branch WT. Use of critical incident reports in medical education. Journal of General Internal Medicine. 2005;20(11):1063–1067.

4.         Theophilos T, Magyar J, Babl FE, Collaborative PRiEDI. Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New Zealand. Emergency Medicine Australasia. 2009;21(6):479–483.

5.         Ireland S, Gilchrist J, Maconochie I. Debriefing after failed paediatric resuscitation: A survey of current UK practice. Emergency Medicine Journal. 2008;25(6):328–330.

6.         Tan H. Debriefing after Critical Incidents for Anaesthetic Trainees. Anaesthesia and Intensive Care. 2005;33(6):768–772.

7.         Campfield KM, Hills AM. Effect of Timing of Critical Incident Stress Debriefing (CISD) on Posttraumatic Symptoms. Journal of Traumatic Stress. 2001;14(2):327–340.

8.         Mitchell AM, Sakraida TJ, Kameg K. Critical incident stress debriefing: implications for best practice. Disaster Management & Response. 2003;1(2):46–51.