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Debriefing to improve outcomes from critical illness : a systematic review and meta-analysis
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Couper, Keith, Salman, Bilal, Soar, Jasmeet, Finn, Judith and Perkins, Gavin D. (2013) Debriefing to improve outcomes from critical illness : a systematic review and meta-analysis. Intensive Care Medicine, Volume 39 (Number 9). pp. 1513-1523. doi:10.1007/s00134-013-2951-7 ISSN 0342-4642.
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Official URL: http://dx.doi.org/10.1007/s00134-013-2951-7
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.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Intensive Care Medicine | ||||
| Publisher: | Springer | ||||
| ISSN: | 0342-4642 | ||||
| Official Date: | 2013 | ||||
| Dates: |
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| Volume: | Volume 39 | ||||
| Number: | Number 9 | ||||
| Page Range: | pp. 1513-1523 | ||||
| DOI: | 10.1007/s00134-013-2951-7 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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