The effect of critical incident debriefing in the emergency department

Abstract

<p>Session E presented Friday, September 28, 10:00-11:00 am</p> <p><strong>Purpose:</strong> Emergency Department (ED) nurses and other staff can feel stressed after critical incidents such as the death of a patient, a violent event, or a medical error. This stress can lead to professional burnout and a decreased sense of personal well-being. Although debriefing sessions are widely recommended as a means of helping caregivers manage stress from critical incidents, there is very little evidence of the impact on job satisfaction and burnout. The objective of this study was to examine the effect of real-time critical incident debriefing on compassion satisfaction, burnout, and secondary traumatic stress in ED staff.</p> <p><strong>Design:</strong> This project was an IRB-approved quasi-experimental research study. The Professional Quality of Life (ProQOL) scale was used to measure compassion satisfaction, burnout, and secondary traumatic stress.</p> <p><strong>Setting:</strong> This study took place in an urban academic Emergency Department with 37,000 annual patient visits.</p> <p><strong>Participants/Subjects:</strong> A convenience sample of ED nurses, patient care technicians, and providers was used. Key inclusion criteria included part-time or full-time employment at the ED in which the study was being performed. Per diem employees and those staff members who did not fall into the above job classifications were excluded. Study participants were provided a letter describing the study and the potential risks and benefits and written consent was obtained. To protect human subjects, study data was presented in aggregate and no individual responses or identifying information was recorded.</p> <p><strong>Methods:</strong> Ten ED charge nurses were identified and specially trained to lead structured real-time debriefings using a critical incident debriefing tool after a predetermined critical incident occurred. All staff members who were directly involved in the incident and/or who self-identified as being emotionally affected by the incident were strongly encouraged to participate. Each debriefing followed a standardized format. The charge nurse led the debriefing within thirty minutes of the event, elicited input from the participants regarding emotion well-being, and provided support and resources in real-time. Study participants received an e-mail containing a link to complete the ProQOL Scale both pre- and post-intervention.</p> <p><strong>Results/Outcomes:</strong> Pre and post-ProQOL survey responses were analyzed using a paired t-test. Preliminary analysis revealed no statistically significant effects on compassion satisfaction, burnout, or secondary traumatic stress, but anecdotal reports from participants were positive. Study limitations included a small sample size and an inconsistent dose of the intervention. Further data analysis is ongoing. Implications: Emergency Department caregivers are routinely exposed to potentially emotionally traumatic events, and leaders have the obligation to promote a healthy working environment that ensures the well-being of their teams. While there are many qualitative studies published on the effectiveness of debriefing on stress management, there is a scarcity of quantitative data that captures the value of debriefing after critical events. This study offered an opportunity to both track critical incidents and help caregivers manage stress from critical incidents in real time. Further data analysis will provide insight into the effect of debriefing on compassion satisfaction, burnout, and secondary traumatic stress. This study can easily be replicated in Emergency Departments nationwide to support ED staff after critical incidents have occurred.</p>