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

Couper, Keith and Salman, Bilal and Soar, Jasmeet and Finn, Judith and Perkins, Gavin D (2013) Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis. Intensive care medicine, 39 (9). pp. 1513-23. ISSN 1432-1238. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://link.springer.com/article/10.1007%2Fs00134-...

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: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WL Nervous system. Neurology > WL800 Pain
WO Surgery > WO500 Anaesthesia
Divisions: Clinical Support > Anaesthetics
Clinical Support > Critical Care
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 03 Feb 2015 13:44
Last Modified: 03 Feb 2015 13:44
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/783

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