ACADEMIC AFFAIRS COMMITTEE AND WELLNESS COMMITTEE
Breaking Burnout with an Emergency Department Debrief Allison Lane, MD and Lisa Stoneking, MD
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he Emergency Department (ED) is a high-stress environment where staffing shortages, legal documentation requirements, and high acuity medical presentations, among other stressors, can all quickly lead to an exhaustive or even hazardous work environment.1 Functioning at its best, the ED operates with a certain level of organized chaos, drawing many thrill-seeking professionals to the field. However, the slightest disturbance in the workflow can drastically alter the operating environment of the ED, and over time, if left uncorrected, can contribute to burnout. Many programs and facilities have begun to utilize post-event, real-time debriefing exercises to combat this stress and reduce staff burnout. Burnout is multifactorial and different from person to person, but themes that remain consistent in most health care professionals include emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment.2 While it may initially sound like a physician’s problem, burnout is a public health issue in that it leads to two times the risk of medical errors.1 Depersonalization and compassion fatigue carry the potential of resultant carelessness, placing both the patient and physician at risk of harm. And as expected, physician burnout in the post-COVID era is on the rise. Emergency medicine has seen the most significant increase in burnout, which has steadily increased from 45% in 2018 to 65% in 2022, according to the “Medscape Physician Burnout & Depression Reports.”3 With burnout comes the exodus of physicians from the field in effort to find more fulfilling or less stressful ways of earning income. This exodus leaves gaps in ED staffing which delays patient turnover, further congests the system, and contributes to the compounding cycle of stress within the ED.
Debriefs offer a way out of the cycle for many departments and can increase physician longevity. The benefits of debriefs expand beyond that of the individual physician. Interdisciplinary debriefs benefit all personnel involved in the patient encounter and should not be restricted to physicians, residents, or even nursing staff. In one study analyzing the behaviors of first responders who completed a debrief following an adverse or traumatic patient encounter,
inhibiting or biasing the discussion. Other team members may not feel welcome or willing to contribute or participate. In addition, there are studies showing lack of utilization by attending physicians. In response, some departments are choosing nurse initiated or led debriefings to increase the frequency and quality of the debriefing session. Regardless of the system used, guidelines must be established, including who initiates and leads the debrief, what is
Debriefing Card Charge Nurse please read statements below prior to starting 1) “The purpose of debriefing is for education, quality improvement, and emotional processing; it is not a blaming session. Everyone’s participation is welcome and encouraged.” 2) “These debriefings usually take several minutes and if you have urgent issues to attend to you are welcome to leave at any time.” 3) “We will briefly review the patient’s summary. Then as an entire team, we can discuss what went well and what could have gone better. Please feel free to ask any questions.” Figure 1
there were statistically significant reductions in alcohol use post-event compared to control groups who did not complete a debrief.4 Apart from the psychological benefits of debriefs, studies have demonstrated improved clinical outcomes with utilization of debriefs as well, including improved rate of return of spontaneous circulation, neurologic outcomes, hands-off compression times, and time delay to first compression following post-event debriefs in clinical cardiopulmonary resuscitation events.5 With benefits including improvement in quality of care expanding to improvement in quality of life and/or work atmosphere, debriefs appear to be a necessary, but underutilized, tool within the health care system. Most ED debriefs involve the entire patient care team and are typically physician led. There is some data, however, that cautions against having an authority figure leading for fear of
“Debriefs offer a way out of the cycle for many departments and can increase physician longevity.”
discussed, where the debrief occurs, and the allotted time for these discussions to succeed. The debriefing should occur as soon as possible after the event, occur over a maximum of 10 to 15 minutes, and all members should be encouraged to give feedback or ask questions.6 An example would be a charge nurse initiated debrief paged out to all involved staff to meet in the doc box for a 10-minute post event >> COMMON SENSE SEPTEMBER/OCTOBER 2023
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