Briefing for Better Cardiac Arrest Outcomes: Top Strategies to Use

If you’ve been following us for awhile, you probably already know that we’re big proponents of regularly conducting hot debriefs immediately after Code Blue events. And for good reason: Studies show that hot debriefs come with all sorts of benefits, from increased team cohesion, to reduced feelings of stress and disengagement, to improved patient outcomes.^1-3

But here’s the thing: Hot debriefing isn’t the only briefing strategy that teams and responders looking to elevate their code performance might want to turn to. Depending on the situation, clinicians also have a lot to gain from conducting a pre-brief to get on the same page at the very beginning of the code (a strategy that’s particularly beneficial to emergency department responders), or from holding monthly or quarterly cold debriefs that look at cardiac arrest response data in aggregate.

And like most things, there’s no one-size-fits-all solution here. The reality is that many hospitals would probably benefit from using some combination of all three. Ready to determine what works best for your hospital? Stay tuned as we dive into the three types of briefing strategies, pros and cons of each approach, and sample formats for immediate real-world application.

Pre-briefing

Overview and Purpose:  Best suited for emergency department (ED) teams that may have advance notice of an incoming arrival, pre-briefs can be instrumental in getting the team on the same page at the beginning of — or just prior to — an event.^4,5

Who’s Involved: The Code Blue team that’s convening for the event.

Pros:

• Can create a brief moment of calm before the code begins.
• Great for establishing a shared mental model, which is key for team cohesion, communication, and to ensure everyone is moving in the same direction.
• Can be used to assign roles for the code at the outset, which will increase team efficiency and avoid confusion or duplication of effort.

Cons:

• Pre-briefs work best in cases where the team has advance notice of the code (for example, if the ED team gets a heads up that an out-of-hospital arrival is on its way). On the flip side, they are much harder to pull off when the code is unexpected, such as a hospital patient who deteriorates with little warning. In those instances, a brief pause at the beginning of the code to discuss the situation and delegate tasks — in lieu of a full-blown pre-briefing — can still be useful.⁴
• Limited information may be available at this point, so the code team must be prepared to pivot and change tack quickly as the code progresses.

Sample Format^4,5

• Share what is known about the patient: status, underlying etiology, additional complications, etc.
• Discuss the immediate plan: Where is the team headed in the first few minutes of the code?
• Assign team roles and tasks
• Ask the team for feedback/input: Is there anything we’re missing?

Hot debriefing

Overview and Purpose: In a hot debrief, the team that responded to the event convenes immediately afterward to review available data, discuss what went well, and highlight what could be improved next time.

Who’s Involved: The Code Blue team that just responded to the event.

Pros:

• The event is fresh in everyone’s minds, so feedback is more likely to stick.
• The discussion focuses solely on the code that just occurred, so takeaways will be more personal and relevant to each individual in attendance.
• More likely to gain full participation of the team since there is no gap between the event and the debrief that follows.

Cons:

• Data may be limited in the immediate aftermath of the event, which can reduce the effectiveness of the feedback.
• Especially if the patient didn’t survive, team members may need more time to process the event before they can take in and apply lessons learned.
• Clinicians may feel defensive if the feedback is not offered constructively.
• Time constraints can come into play due to other clinical demands.

Sample Format^3,6,7

• Introduction: Thank everyone for attending and state the goals of the hot debrief.
• Reactions: Have participants briefly reflect on their feelings and reactions to the code.
• Overview: Provide a quick clinical summary of the code. This is a good opportunity to include objective data on cardiopulmonary resuscitation (CPR) quality and adherence to Advanced Cardiac Life Support (ACLS) algorithms.
• Plus/Delta analysis: Ask the group what went well, and what they would do differently.
• Summary: Quickly review the main discussion points and key takeaways before the group disperses.

Cold debriefing

Overview and Purpose: To review aggregate data from Code Blue cases across the hospital during a set period of time.

Who’s Involved: Unlike pre-briefs and hot debriefs, cold debriefs are an opportunity to open up the discussion to a wider group of people (e.g., all clinicians who are regularly involved in codes and would benefit from the review).

Pros:

• More data available than in the immediate aftermath of a code.
• Organizers have time to prepare for the session and collect/analyze data to ensure that the review is as useful as possible.
• Can cast a wider net and include more people than just the specific Code Blue team involved.
• Clinicians won’t be fresh off the stress of an event, so they may be more receptive to feedback or perceive it as a safer environment to receive feedback.⁸
• Offers the ability to zoom out, put Code Blue performances in a larger hospital-wide perspective, and track trends throughout the hospital over time.

Cons:

• Feedback and takeaways will always be less individualized and personal when looking at aggregate data.
• This type of review is unlikely to yield useful or actionable insight on specific team dynamics.

 Sample Format:

• Introduction: Thank everyone for attending, state the goals of the cold debrief, and note the time period that you’ll be covering in the review.
• Overview of events: Provide the basic stats (e.g., total number of codes that occurred in the established timeframe, breakdown of events by location, etc.)
• Presentation of key metrics: Share key indicators of performance such as high-quality CPR metrics, time to defibrillation, adherence to ACLS protocols, and more.
• Discussion of trends, patterns, strengths, & weaknesses: This is where the extra preparation and analysis that cold debriefs allow for can really shine. Use this opportunity to zoom out and discuss trends over time, recurring areas of strength or weakness, and other data that would be difficult to have on hand immediately after an event.
• Q&A: Open up the session to the whole group to ask questions and provide feedback/thoughts.