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  • Writer's pictureStephen Harden

Surgical Briefing and Debriefing to Improve Patient Safety

Updated: Jun 7, 2018

The value of a debriefing after a surgical procedure cannot be underestimated. It has been linked to improved performance in various medical and surgical fields, including improvements in specific procedures, teamwork communication, error identification, improved communication, and professionalism.

A recent study of the effectiveness of a debriefing process was published in 2012. The study details how a briefing/debriefing tool was implemented in the ORs of a hospital. In 44 months of use, the tool identified 6202 defects (issues with instrumentation, radiology, laboratory, supply, and communication/safety, etc.).

(Wouldn't it be awesome if you had a system in your hospital to identify and fix this number of defects in process of care?)

The list of errors identified during briefing or debriefing was sent to administrative personnel so they could begin to address them at ther surgical service weekly meeting, and was provided on a monthly basis to administration. Staff members and physicians were informed of the steps being taken to resolve issues on a daily basis by the clinical outcomes nurse (for staff members) or the administrative nurse manger (physicians).

This study, among several others, showed that briefings and debriefings were a practical and successful means of identifying and fixing both clinical and operational errors in surgical care.

To achieve this level of effectiveness, debriefing MUST be done...

  • Consistently - after every procedure, even when things go well. Otherwise debriefings will become associated with poor outcomes or bad behavior. If you don't debrief when things go well, you won't debrief when things go poorly.

  • As soon after a procedure as possible and with all team members involved - including the surgeon.

  • For the express purpose of identifying and communicating systemic issues to the proper hospital administration, which MUST keep the OR staff updated on the progress of remedying the issue. If you are not going to bother fixing the issues identified in debriefings, don't waste your time implementing a debrief system.

Debriefing can be a powerful tool in creating team unity and awareness, as well as reducing errors, which in turn lead to amore enjoyable working environment for medical personnel and a safer operative experience for the patient. In my 12 years of experience of helping hospitals improve patient safety, a debriefing system is THE MOST POWERFUL TOOL available to create a culture of safety - but it also the most difficult tool to implement well. Making the effort to implement it is worth the difficulty, but only if you are willing to adhere to the three rules above.

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It is interesting that all high performing military teams are disciplined about debriefing their performance and have built debriefing into their processes and deeply embedded it in their cultures. The Blue Angels, Thunderbirds, Green Berets, Army Rangers, Navy SEALS, and Delta Force are just a few of the elite teams that constantly debrief. Most military organizations won't implement any process that is not simple and repeatable under the pressure of combat. Therefore, there must be a connection between their performance and their willingness to repeatedly debrief.

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