JINKA GENERAL HOSPITAL

BRIEFING & DEBRIEFING PROTOCOL

BY OR & QI-DIRECTORATES SEPTEMBER 2023

JINKA SRG ETHIOPIA

Contents
page
INTRODUCTION...........................................................................................................................2

Briefing............................................................................................................................................2

Quick Guide to Briefing...............................................................................................................4

Debriefing........................................................................................................................................5

Quick guide to debriefing............................................................................................................5

Briefing and Debriefing for surgical ward rounds.......................................................................7

Conclusion.......................................................................................................................................7

REFERENCES:...............................................................................................................................8

Annex Briefing & Debriefing Check List.......................................................................................9

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INTRODUCTION
Briefings and debriefings are often a simple verbal interchange, rather than a paper checklist to
work through. They are not intended to replace or duplicate the surgical safety checklist. Both
briefing/debriefing and checklist techniques are intended to complement each other, build
teamwork, improve communication and reduce errors. This is important because patient safety is
improved when teams communicate well and work well together. There is no single or right way
to brief or debrief. Like surgical safety checklists, they should be tailored for each theatre.
Approximately half of hospital adverse events are associated with theatre procedures. Surgical
complications and adverse outcomes have been linked to a lack of communication and
coordination among surgical teams. Briefings help create a broader knowledge base for the
planned surgical list so each team member has a better understanding of the tasks at hand, and
can anticipate future events and plan accordingly. Debriefings enable teams to take time to learn
from real-time situations that went well or didn’t go to plan by discussing what happened after an
operating session.
There is strong evidence to support the use of surgical briefings and debriefings to reduce patient
harm. In a 2015 article in the Australian and New Zealand Journal of Surgery, Civil and Shuker
note that ‘briefings and debriefings in the theatre environment have reduced communication
failures by two-thirds, reduced non-routine events by 25 percent, and increased their sense of
team collaboration.
The Patient Safety First Campaign was established to support implementation when the NPSA
issued their alert informing England and Wales to use the checklist. Patient Safety First reported
that some elements of the checklist could be more effective if incorporated into a briefing before
the list starts. This is an opportunity to make a plan for the list, amongst all the team members, to
anticipate and plan for any problems that can be foreseen.

Patient Safety First developed and promoted the ‘Five Steps to Safer Surgery’

Figure 2: Five Steps to Safer Surgery

The ‘Five Steps to Safer Surgery’ helps to highlight issues at the start of the day and enables
early resolution to minimize negative impact on theatre safety

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Briefing
Briefings are a communication and teamwork tool that support the sharing of information and
early identification of potential hazards. Briefings allow any issues that might affect the smooth-
running of the surgical list to be identified early, such as patient, staffing or equipment issues.
They also provide an opportunity to identify any human factors that can lead to error, including
tiredness and fatigue, nutritional or emotional state, multi-tasking and loss of awareness.
A briefing is a short meeting between all theatre team members to ensure that there is a shared
understanding of what is expected of them and the role of other team members. Briefings enable
the sharing of the operative plan, promote teamwork, mitigate hazards to patients, reduce
preventable harm and ensure all equipment is available. They supply a broader knowledge base
for the planned procedure so each team member has a better understanding of the tasks at hand,
and can anticipate future events and pre-plan accordingly.
A briefing takes place at the start of the list, before an operating session, and lasts for a few
minutes. Everyone is at the same start point, surprises are avoided, and there is a positive impact
on how the team works together
Briefing was carried out just before starting the surgical ward round &all the members of the
surgical team carried out following tasks in briefing:-Introduction, Role and job allocation, Route
of the round, Triaging patients, Logistical issues that require extra attention
An example of the flow of the briefing discussion is that it opens with team introductions, which
include the name and role of each team member. Any staffing issues are talked through, such as
sickness; anesthetic safety checks are usually included at this stage; changes to the list or
clarification about the list are discussed; equipment and instrumentation issues are
communicated; and the time for the list is confirmed.
A briefing should provide the following opportunities for team members to:
 Gain clarity of direction
 Facilitate better coordination between team members
 Reduce the risk of problems and breakdowns in communication occurring
 Develop contingency plans for if unexpected events happen
 Clarify any misunderstanding of plan or approach
 Create a culture of open communication & Make everyone feel part of a team
 To learn availability of manpower resources.
 To learn about capability and efficiency resources.
 To find out logistical and technical issues well in advance and plan to resolve them.
At a minimum, briefings should include discussion around drug sensitivities, patient information
relevant to the procedure, anesthesia type, availability of blood products, equipment and planned
stages of surgery.

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 Quick Guide to Briefing
What is it? The plan for the day is discussed by all team members
When? Initiate the briefing before the first case of the day, once all team members are available in
the department
Why? Ensure a shared understanding of the plan for the day
Anticipate and prepare for problems
Who is leading It can be any member of staff
the briefing? Consider rotating the lead including and encouraging junior staff/ trainees?
People Team members introduce themselves
Clarify roles, responsibilities, actions and interactions - who’s doing, what, where, when
Who’s missing?
Does everyone feel comfortable about today?
Qualify any supervision/assessment considerations
Remember – we’re part of a team
Everybody has a valid role, perspective and opinion
Additional personnel, e.g., multi-speciality case/ perfusionists/ radiography
List Highlight any issues arising from the previous list’s debrief
Overview of the list
 Any changes?
 Anticipated events, e.g., Fire Alarm test, Industry observer
 If emergency procedures are needed what changes may be necessary?
Details of each case
Be clear about the plan, expectations, special considerations, eg, latex allergy/positioning
Equipment What, where, when and how
Loan equipment
Decontamination Issues
Consumables
Questions and Check for any misunderstandings
concerns Ask the team to highlight potential risks and hazards
Identify and discuss contingency and mitigation plans
Agree when the debrief will be performed

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 Debriefing
Debriefing occurs at the end of an operating session and involves all members of the theatre
team. It allows the team to assess what they did well, what the challenges were and what they
will do differently next time. The debriefing discussion flow begins with what went well;
discussing if the team performed effectively; discussing any communication issues; discussing
what might have been done differently and other learning points; review of the timing of the
operating list (was there enough time/was there too much time?); and closing with checking
whether the debriefing helped the team.. The opportunities that arise from regular participation in
debriefing meetings include:
 Improved communication across all disciplines
 Practice improvement
 Equipment, personnel and technology issues to be identified and addressed
 To learn lessons and improve performance in future
A five-minute debriefing should be completed in theatre at the end of the patient list. The poster
on the wall prompts the discussion. The debriefing is completed verbally. It will be important to
capture informally any actions arising from the debriefing to ensure that identified issues are
resolved and suggestions for improvement acted on.
During the debriefing team members are encouraged to raise any concerns or suggestions they
may have had during any of the operations on the list. Discuss what went well and not so well,
what can be improved or done better next time, and why.
As part of debriefing, organizations must implement some kind of action-feedback loop for
instances where changes or improvements need to be made.
Quick guide to debriefing
What is it? A discussion of the day’s list and an opportunity to learn from what went well and what didn’t

When? Perform the debrief before team members start leaving the theatre/ department

Why?  Aim is to improve rather than blame

 Opportunity to feedback on team learning
 Capture problems, trends and near misses

Who is  It can be any member of the team

leading the  Consider rotating the lead including students and trainees?
debriefing?  Consider giving the lead to the team member who is often the first to leave the theatre

How to  Reflect; sharing information and perspectives

debrief  Own personal views, start sentence with ‘I’
 No direct criticism or blame
 Openness and honesty

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  Encourage everyone to contribute
 Acknowledge, glitches, mistakes, distractions and interruptions
 Reflect on your own work as well as others
 Think about individual, team and system contributors to events
 End on a high/positive learning point
What went  Did you work as well as you could have? If not, why?
well and  Did you speak up when you needed to?
why  Was the whole team present?
 Did we work well as a team – were we well prepared?
 How was the atmosphere in theatre?
 Was the briefing beneficial? Was anything missed out?
What didn’t Were there any times when you didn’t know what was going on?
go well and Were there any surprises?
why Were there any errors? Violations?
Were there any potential errors or glitches? Were they linked to:
– Equipment? – Leadership?
– Environment? – Communication?
– Process? – Decision making?
– Planning? – Training?
– Time pressures? – Staffing?
– Distraction/interference – External influences? – What’s happening in the Trust??
Close the  Record successes and learning points
loop:  What do we need to change?
Record,  Does anything require escalation?
feedback  What can we do ourselves? Who will take forward?
and actions  What do we need external or senior support for? Who will take forward?
 Record actions

Briefing and Debriefing for surgical ward rounds.

Briefing Debriefing
Personal Personal
All team members present. What went well?

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Introduction (Name, role, other possible role). Room for improvement (task distribution, delegation,
Any concerns (Fitness, early leaver?). feedback, suggestions for improvement).
Performance and learning goals (expected finish
time, learning for juniors and medical students).
Patients Patients
Triaging patients. Deviations from initial triaging.
Navigation route for surgical ward round. Deviations from planned route.
Patient list with updated location and the results of Issues with location of patient.
investigations or planned investigations. Issues with investigations.
Suggestions for improvement
Planning Planning
Job delegation among team members and any Were there logistic problems?
deviation if required. Problems with equipment?
Who is leading the surgical ward round Learning goals achieved?
Time and place of debriefing. Who takes responsibility for looking back the suggestions
for improvement?

Conclusion
Briefings should set the style and tone for an operation. Briefing provides the information needed
to direct deployed resources. This information is also used for debriefing personnel in order to
obtain further relevant, available information. Ongoing education and consistent implementation
of these protocols will improve the co-ordination of surgical teams and reduce the risk of poor
patient outcomes.
The value of debriefing has been strongly established. Debriefing can be a powerful tool in
creating team unity and awareness, as well as reducing errors, which in turn leads to a more
enjoyable working environment for medical personnel and a safer operative experience for the
patient.
However, the successful design of a debriefing module is not tantamount to successful
implementation, and the implementation of a debriefing module has proved challenging. Poor
compliance is most likely multifactorial, resulting from a medical culture prided on individuality
and expertise in conjunction with surgical safety checklists, briefing and debriefing sessions are
most successful when they are planned and integrated into the day-to-day practice of surgical
teams.

REFERENCES:
1) Civil, I., and Shuker, C. 2015, Briefings and debriefings in one surgeon’s practice. ANZ J
Surg 85 (2015) 321–323

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 2) Allard, J. et al, Pre-surgery briefings and safety climate in the operating theatre. BMJ
Qual Saf. 2011 Aug; 20(8):711-7.
3) Marks S, et al. 2014. Surgical team debriefing and follow-up: creating an efficient,
positive operating room environment to improve patient safety. APSF Newsletter.
Indianapolis: Anesthesia Patient Safety Foundation
4) Royal Australian college of surgeon briefing & debriefing protocol 2016
5) Health quality & safety commission newzerland an evidence summary Updated August
2016
6) International Journal of Surgery Research and Practice Sajid et al. Int J Surg Res Pract
2022
7) Health quality & safety commission New Zealand updated: 8th December, 2021

Annex Briefing & Debriefing Check List

BRIEFING CHECK LIST DEBRIEF CHECKLIST

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 Who is on core team?  Communication clear?
 All members understand and agree upon  Roles and responsibilities understood?
goals?  Situation awareness maintained?
 Roles and responsibilities understood?  Workload distribution?
 Plan of care?  Did we ask for or offer assistance?
 Staff availability?  Were errors made or avoided?
 Workload?  What went well, what should change, what
 Available resources? can improve?
 proper documentation fulfilled

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