Use of a team immediate debrief tool to improve staff well‐being after potentially traumatic events

It is inevitable that anaesthetic, theatre and ICU staff will encounter critical incidents, deaths in theatre and other potentially traumatic events during their working lives [1]. Despite introducing trauma risk management (TRiM) at our hospital, a peer support tool that helps staff prepare for and recover from potentially traumatic events [1, 2], we identified four issues which we believed were negatively affecting staff well-being following such events: firstly, staff were not always aware of the normal reactions they might experience after a potentially traumatic event and the steps they could take to mitigate these; secondly, senior staff often found it difficult to carry out short team debriefs immediately after such traumatic cases, especially if they were affected themselves, adding to their anxiety; thirdly, our hospital TRiM system was not being utilised to its maximal potential, with TRiM assessments not always requested following potentially traumatic events; and fourthly, incomplete lists of staff involved in a potentially traumatic event resulted in some staff missing TRiM assessments and the subsequent support available to them. We therefore worked closely with our clinical psychologists to develop a cognitive aid that could be used by frontline clinicians immediately after a potentially traumatic event, a team immediate debrief (TID) tool, with information about ‘psychological first aid’ printed on the back (Fig. 1). This was designed to be displayed on the wall in operating theatres and ICU and used immediately after a potentially traumatic event, to enable a simple, short, fast and effective immediate debrief, and encourage a complete list of staff involved to be recorded immediately, TRiM referrals to be made and staff well-being promoted. We designed and delivered a TID tool awareness campaign to familiarise the operating theatre and ICU multidisciplinary team with the purpose of the TID, its objectives and method of use, and sought feedback for further improvement. Multidisciplinary staff were invited to take part in small group ‘tea trolley’ training sessions [3], modified in order to be COVID-19 secure, and to complete feedback forms immediately afterwards. Seventy staff received training and 37 completed feedback forms (a response rate of 53%). Before training, 5 (13%) reported they felt very, or quite, confident to use the TID and 28 (78%) had never used it. Following training, 30 (81%) reported they felt very, or quite, confident to use the TID. Free comments included the need to simplify the TID further, to consider whether any staff member (and not just senior staff) could lead an immediate debrief and to clarify situations in which it could be used. Twenty-three staff (62%) reported specific situations they had been involved with when the TID would have been useful, including blocked tracheal tubes in ICU; difficult tracheal intubations; difficult paediatric cases; cardiac arrests; deaths in theatre; and ICU cases during the COVID-19 pandemic first wave. Thirty-six (97%) participants reported that they would recommend the use of the TID to other hospitals. In conclusion, the TID proved to be a popular tool for promoting and standardising immediate multidisciplinary team debriefs following potentially traumatic events. Staff reported that the tool improved confidence in leading an immediate debrief, gave them a better understanding of the processes to follow and improved their awareness of the psychological support available to them and their team. We thank Drs S. Gouldson, M. Edmondson, M. Osborn, S. Shatwell, K. Herneman and Professor N. Greenberg for their work and contributions towards the development of the TID tool. No competing interests declared.