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Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis

Abstract

Purpose

Intensive care clinicians play a central role in the co-ordination and treatment of patients that develop life-threatening emergencies. This review evaluates the effect of debriefing after life-threatening emergencies and considers the implications for intensive care training and practice.

Methods

Studies were identified by searching electronic databases, citation tracking, and contact with subject specialists. Studies evaluating the effect of debriefing after life-threatening emergencies on clinician performance (process) and/or patient outcomes were eligible for inclusion. Study quality was assessed and summarised using the GRADE system.

Results

The search identified 2,720 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 non-technical performance (n = 4) and technical performance (n = 16), and improved patient outcomes (n = 2). Four cardiac arrest studies were suitable for meta-analysis. This found evidence of improved resuscitation process outcomes [compression fraction (mean difference 6.80, 95 % CI 4.19–9.40, p < 0.001)] and short-term patient outcome [return of spontaneous circulation (OR 1.46, 95 % CI 1.01–2.13, p = 0.05)]. There was no effect on survival to hospital discharge (OR 0.80, 95 % CI 0.38–1.67, p = 0.55).

Conclusions

This 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 long-term patient outcomes is uncertain. There remains a need for further high-quality research, which seeks to identify the optimal method for debriefing delivery and effect on patient outcomes.

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Acknowledgments

We 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. K.C. is supported by a Resuscitation Council (UK) Research Fellowship. G.D.P. is supported by the Intensive Care Foundation.

Conflicts of interest

K.C.: European Resuscitation Council (travel/accommodation). J.S.: ILCOR Advanced Life Support Task Force Co-Chair (voluntary), Editor of the journal Resuscitation (paid), European Resuscitation Council and American Heart Association (travel/accommodation). J.F.: ILCOR Education, Implementation and Teams Task Force Co-Chair (voluntary), American Heart Association (travel/accommodation); and Director of the Australian Resuscitation Outcomes Consortium (Aus-ROC) for which she receives partial salary support. G.D.P.: ILCOR Advanced Life Support Task Force Co-Chair (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). B.S. has no conflicts of interest. K.C. 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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Correspondence to Gavin D. Perkins.

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Couper, K., Salman, B., Soar, J. et al. Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis. Intensive Care Med 39, 1513–1523 (2013). https://doi.org/10.1007/s00134-013-2951-7

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Keywords

  • Emergency
  • Intensive care
  • Cardiopulmonary resuscitation
  • Healthcare quality assessment
  • Debriefing
  • Feedback