Debriefing after failed paediatric resuscitation: a survey of current UK practice S Ireland, 1 J Gilchrist, 2 I Maconochie 3 1 Emergency Medicine Department, Northern General Hospital, Sheffield, UK; 2 Sheffield Children’s Hospital, Sheffield, UK; 3 St Mary’s Hospital, London, UK Correspondence to: Dr S Ireland, Emergency Medicine Department, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK; sianireland@yahoo.co.uk Accepted 3 November 2007 ABSTRACT Objectives: Debriefing is a form of psychological ‘‘first aid’’ with origins in the military. It moved into the spotlight in 1983, when Mitchell described the technique of critical incident stress debriefing. To date little work has been carried out relating to the effectiveness of debriefing hospital staff after critical incidents. The aim of this study was to survey current UK practice in order to develop some ‘‘best practice’’ guidelines. Methods: This study was a descriptive evaluation based on a structured questionnaire survey of 180 lead paediatric and emergency medicine consultants and nurses, selected from 50 UK trusts. Questions collected data about trust policy and events and also about individuals’ personal experience of debrief. Free text comments were analyzed using the framework method described for qualitative data. Results: Overall, the response rate was 80%. 62% said a debrief would occur most of the time. 85% reported that the main aim was to resolve both medical and psychological and emotional issues. Nearly all involve both doctors and nurses (88%); in over half (62%) other healthcare workers would be invited, eg, paramedics, students. Sessions are usually led by someone who was involved in the resuscitation attempt (76%). This was a doctor in 80%, but only 18% of responders said that a specifically trained person had led the session. Individuals’ psychological issues would be discussed further on a one- to-one basis and the person directed to appropriate agencies. Any strategic working problems highlighted would be discussed with a senior member of staff and resolved via clinical governance pathways. Conclusions: Little is currently known about the benefits of debriefing hospital staff after critical incidents such as failed resuscitation. Debriefing is, however, widely practised and the results of this study have been used to formulate some best practice guidelines while awaiting evidence from further studies. Debriefing is a form of psychological ‘‘first aid’’ that has its origins in the military. General Marshall, chief historian of the United States Army during World War II, advocated the use of debriefing techniques and sessions on the battle- field. The sessions were intended to gather information about the fighting day, but he noticed they had a spiritually purging and morale-building effect on the troops. 1 Debriefing moved into the spotlight in 1983, when Mitchell 2 described the technique of critical incident stress debriefing (CISD). It forms part of the wider strategy known as critical incident stress management, which comes under the umbrella term of ‘‘crisis management’’. In CISD the debrief- ing is provided after a traumatic event and is a structured, seven-stage, group session provided 24– 72 h after the event, facilitated by skilled mental health workers and trained peers. It was initially described for use in pre-hospital emergency work- ers in the United States and was mandatory, taking 3–5 h to complete. Over the years debriefing has come to mean many different things and is usually not the formal CISD technique described by Mitchell. 2 It has been applied to a wide variety of groups of individuals including trauma victims, women after childbirth, cancer patients, rescue workers involved in natural disasters, rape victims, children in schools where traumatic incidents have taken place and many other situations. A Cochrane review, published in 2002, was updated in 2006. 3 The authors concluded that ‘‘there is no evidence that single session psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.’’ None of these studies truly looked at the Mitchell model of CISD. Interventions were conducted with individuals rather than groups and many times it occurred outside of the 24–72 h window described by Mitchell. 2 The Cochrane review has, however, fuelled the debate on the usefulness of CISD. In 1997, Mitchell and Everly 4 published a review of the evidence for CISD. They cited a number of studies that use the Mitchell model in groups of pre-hospital emergency workers, who found ben- efits from the intervention, such as a reduction in the signs and symptoms of distress. To date little work has been carried out on debriefing hospital staff. At the 2004 Association of Paediatric Emergency Medicine autumn meeting, a session was dedicated to debriefing after failed paediatric resuscitation. It became clear from the discussions that debriefing was frequently carried out, but not to any particular standard and without good evidence for its effectiveness. It was suggested that, as the practice of debriefing seems popular and is endorsed by a number of organisations, it might be sensible to review the literature and survey current practice in order to aid the devel- opment of some ‘‘best practice guidelines’’. This is the basis of this study. METHODS Study design This study was a descriptive evaluation using a structured questionnaire survey of clinicians in UK hospitals. The questionnaire collected general data regarding trust policy and practice and also information about individuals’ own experience of debriefing after failed paediatric resuscitation. Original article 328 Emerg Med J 2008;25:328–330. doi:10.1136/emj.2007.048942 group.bmj.com on August 8, 2016 - Published by http://emj.bmj.com/ Downloaded from