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Home E-Weekly July 15, 2014

Brief and Debrief to Improve Surgical Outcomes

Published: July 14, 2014

Thoughtfully structured briefings and debriefings have the potential to dramatically improve surgical communication and outcomes, a recent study in JAMA Surgery suggests.

The briefings, say the authors, go beyond traditional time outs in that team members introduce themselves by name and role before the time out, then conduct a formal review after the time out. It may sound extensive and time-consuming, they say, but studies show that effective briefings can be done in less than 2 minutes, and that they can reduce surgeon-reported delays by more than 80%.

Pre-operative briefings, including a discussion of information relevant to the procedure, can improve communication, decrease surgical workflow disruptions, improve compliance with antibiotic and deep vein thrombosis prophylaxis, and improve overall perceptions about the safety climate in the OR, say the authors. But, they caution, providers must be committed to the process for briefings to be effective.

Debriefings, along with addressing housekeeping points after the case, should provide an opportunity for unstructured feedback regarding process defects, and a system should be put in place to address defects that are revealed. The authors provide this example: "One of the SSI prevention interventions implemented by the team was isolation of dirty instruments used for bowel anastomosis. Nurses and technicians said this was difficult because the surgeons did not communicate when they were starting and ending the 'dirty' portion of the procedure. … The surgeons decided to include this point in the briefings as well."

Jim Burger

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