Newly Published
Education  |   March 2019
Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event
Author Notes
  • From the Department of Anesthesiology and Critical Care, University of Pennsylvania Health System (A.F.A., R.E.S., J.T.C., M.M., R.C.B., E.K.B.G., S.A.F., D.Y.B., L.A.F.); the Center for Perioperative Outcomes Research and Transformation (R.E.S., J.T.C., M.M., R.C.B., L.A.F.); Perelman School of Medicine (R.E.S., R.C.B., L.A.F.), University of Pennsylvania, Philadelphia, Pennsylvania; the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital (A.F.A.); the Center for Surgery and Public Health (A.F.A.); and Ariadne Labs (A.F.A.), Boston, Massachusetts.
  • Prior presentations of this topic on earlier project stages were presented at the 2017 Annual Meeting of the Association of University Anesthesiologists in Washington, DC, on May 5, 2017 and the 2017 Annual Meeting of Academy Health in New Orleans, Louisiana on June 24, 2017.
    Prior presentations of this topic on earlier project stages were presented at the 2017 Annual Meeting of the Association of University Anesthesiologists in Washington, DC, on May 5, 2017 and the 2017 Annual Meeting of Academy Health in New Orleans, Louisiana on June 24, 2017.×
  • Submitted for publication August 17, 2018. Accepted for publication January 12, 2019.
    Submitted for publication August 17, 2018. Accepted for publication January 12, 2019.×
  • Correspondence: Address correspondence to Dr. Arriaga: Department of Anesthesiology and Critical Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115. aarriaga@bwh.harvard.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Airway Management / Cardiovascular Anesthesia / Critical Care / Education / CPD / Patient Safety
Education   |   March 2019
Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event
Anesthesiology Newly Published on March 1, 2019. doi:10.1097/ALN.0000000000002649
Anesthesiology Newly Published on March 1, 2019. doi:10.1097/ALN.0000000000002649
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation.

What This Article Tells Us That Is New:

  • Failure to debrief after critical events is common among anesthesia trainees and likely anesthesia teams. Communication breakdowns are associated with a high rate of the failure to debrief.

Background: Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors’ objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel.

Methods: At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings.

Results: During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers.

Conclusions: Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief.