DEEP DIVE - Clinical Event Debriefing with Prof Walter Eppich and A/Prof Andrew Coggins

(AI) What is clinical event debriefing, how does it differ from the simulation debriefing we all know, and how do you actually make it routine in a busy ED? Emergency clinicians Prof Walter Eppich and A/Prof Andrew Coggins join host Kit Rowe and the team for a deep dive.

The panel works through what "clinical event debriefing" (CED) really means and how it differs from simulation debriefing: it follows a real patient event, is rarely planned, and often happens when the team is most emotionally activated. A central thread is aligning intention with impact — distinguishing debriefing to learn, to manage, and to treat, and the risks of drifting into psychological treatment without the training for it. The bigger missed opportunity, they argue, is reserving debriefing only for catastrophic events, when routine, brief, learning-oriented debriefs build the skills and psychological safety a team needs before the critical case arrives.

Along the way: who should facilitate (and why it shouldn't default to the team leader), end-of-shift check-ins, "coffee and cases," M&M as after-action review, retrieval-medicine debriefing, and the support gap facing senior clinicians — "who debriefs the debriefers?" The consistent takeaway: pick a simple framework and use it, keep it short, lead with shared understanding and humility, and just start debriefing.

Host: Kit Rowe  |  Panel: Pramod Chandru, Caroline Wilson  |  Guests: Prof Walter Eppich (University of Melbourne), A/Prof Andrew Coggins (Westmead)

⏱️ Episode timestamps

• 00:00 – Disclaimer
• 00:13 – Intro music
• 00:30 – Welcome and panel introductions
• 02:08 – Opening question: what is clinical event debriefing?
• 03:04 – CED vs simulation debriefing; the after-action review and its origins
• 04:36 – Key differences: a real patient, usually unplanned, compressed time
• 09:09 – Is CED only for "sinister" events? Reconciling experience with its potential role
• 11:05 – Learning vs caring for traumatised staff; aligning intention and impact
• 14:51 – Support at 3am without a psychologist: psychological first aid (look, listen, link)
• 16:59 – The learn–manage–treat spectrum; the COVID-era genesis of the BMJ paper
• 21:46 – Who should lead a debrief? Charge-nurse facilitation; self-led teams
• 27:34 – Debriefing the shift rather than the single event; translational simulation
• 30:16 – The STOP5 hot-debrief tool
• 30:47 – What to ask in a routine end-of-shift debrief
• 32:08 – Pramod's case (fat embolus, cardiac arrest); "who debriefs the debriefers?"
• 33:21 – Andrew's observational study; check-ins and building psychological safety
• 35:44 – Peer support and the loss of community on becoming a consultant
• 38:53 – Making sense of an event with a trusted colleague
• 41:28 – Preparing peers to debrief each other; ongoing research collaboration
• 43:46 – Community of practice; separating coaching/mentorship from debriefing
• 46:03 – Walter's case story: an overnight paediatric tragedy and an informal debrief
• 48:35 – Structure and frameworks: use one, keep it simple; humility as a leader
• 51:01 – Shared understanding and ground rules as the core of a safe debrief
• 52:00 – M&M as after-action review; "outcome review" and ground rules
• 54:11 – Debriefing in retrieval medicine; "coffee and cases"
• 56:02 – "Just start debriefing"; systematic review of tools; the INFO tool; the seatbelt analogy
• 58:56 – Wrap-up: take-home messages from the panel
• 59:47 – Briefing and debriefing synergy; team reflection research
• 1:01:14 – Sign-off

📚 References & resources (in order of discussion)

1. Kolbe M, Schmutz S, Seelandt JC, Eppich WJ, Schmutz JB (2021). Team debriefings in healthcare: aligning intention and impact. BMJ. 2021;374:n2042. https://doi.org/10.1136/bmj.n2042 (~11:05)
2. Keiser NL, Arthur W Jr (2021). A meta-analysis of the effectiveness of the after-action review (or debrief) and factors that influence its effectiveness. Journal of Applied Psychology. 2021;106(7):1007–1032. https://doi.org/10.1037/apl0000821 (~11:44)
3. Keiser NL, Arthur W Jr (2022). A meta-analysis of task and training characteristics that contribute to or attenuate the effectiveness of the after-action review (or debrief). Journal of Business and Psychology. 2022. https://doi.org/10.1007/s10869-021-09784-x (~11:54)
4. Rose S, Cheng A (2018). Charge nurse facilitated clinical debriefing in the emergency department (the INFO tool). CJEM. 2018;20(5):781–785. https://doi.org/10.1017/cem.2018.369 (~22:24)
5. Walker CA, McGregor L, Taylor C, Robinson S (2020). STOP5: a hot debrief model for resuscitation cases in the emergency department. Clinical and Experimental Emergency Medicine. 2020;7(4):259–266. https://doi.org/10.15441/ceem.19.086 (~30:16)
6. Coggins A, De Los Santos A, Zaklama R, Murphy M (2020). Interdisciplinary clinical debriefing in the emergency department: an observational study of learning topics and outcomes. BMC Emergency Medicine. 2020;20(1):79. https://doi.org/10.1186/s12873-020-00370-7 (~33:21)
7. Petrosoniak A, Gabriel J, Purdy E (2022). Stop asking if it works, start making it happen: exploring barriers to clinical event debriefing in the ED. CJEM. 2022;24(7):673–674. https://doi.org/10.1007/s43678-022-00396-9 (~56:28)
8. Phillips EC, Smith SE, Tallentire VR, Blair S (2024). Systematic review of clinical debriefing tools: attributes and evidence for use. BMJ Quality & Safety. 2024;33(3):187–198. https://doi.org/10.1136/bmjqs-2022-015464 (~57:14)
9. Schmutz JB, Lei Z, Eppich WJ (2021). Reflection on the fly: development of the Team Reflection Behavioral Observation System (TuRBO) for acute care teams. Academic Medicine. 2021;96(9):1337–1345. https://doi.org/10.1097/ACM.0000000000004105 (~59:47)

Background reading (referenced in planning; not discussed on air)

• Kessler DO, Cheng A, Mullan PC. Debriefing in the emergency department after clinical events: a practical guide. Ann Emerg Med. 2015;65(6):690–698. https://doi.org/10.1016/j.annemergmed.2014.10.019
• Gillen J, Koncicki ML, Hough RF, et al. The impact of a fellow-driven debriefing program after pediatric cardiac arrests. BMC Medical Education. 2019;19:272. https://doi.org/10.1186/s12909-019-1711-y

Also mentioned

• INFO attitudes study — Rose SC, Asna Ashari N, Davies JM, Solis L, O'Neill TA. Interprofessional clinical event debriefing—does it make a difference? CJEM. 2022;24(7):695–701. https://doi.org/10.1007/s43678-022-00361-6
• Victoria Brazil (Bond University) — translational simulation
• Rebecca Szabo — end-of-list debriefing in operating theatres
• Paul Mullen — structures and logistics for debriefing
• Frameworks named in passing: PEARLS, TALK, REFLECT; and the "advocacy–inquiry" technique

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