title: Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Intensive care clinicians play a central role in the co-ordination and treatment of patients that develop life-threatening emergencies. This review evaluates the effect of debriefing after life-threatening emergencies and considers the implications for intensive care training and practice.
  
  
  METHODS
  Studies were identified by searching electronic databases, citation tracking, and contact with subject specialists. Studies evaluating the effect of debriefing after life-threatening emergencies on clinician performance (process) and/or patient outcomes were eligible for inclusion. Study quality was assessed and summarised using the GRADE system.
  
  
  RESULTS
  The search identified 2,720 studies. After detailed review, 27 studies were included of which 20 supported the use of debriefing. Debriefing was viewed positively (n = 3), improved learning (n = 1), enhanced non-technical performance (n = 4) and technical performance (n = 16), and improved patient outcomes (n = 2). Four cardiac arrest studies were suitable for meta-analysis. This found evidence of improved resuscitation process outcomes [compression fraction (mean difference 6.80, 95 % CI 4.19-9.40, p < 0.001)] and short-term patient outcome [return of spontaneous circulation (OR 1.46, 95 % CI 1.01-2.13, p = 0.05)]. There was no effect on survival to hospital discharge (OR 0.80, 95 % CI 0.38-1.67, p = 0.55).
  
  
  CONCLUSIONS
  This review supports the use of structured debriefing as an educational strategy to improve clinician knowledge and skill acquisition and implementation of those skills in practice. However, the effect of debriefing on long-term patient outcomes is uncertain. There remains a need for further high-quality research, which seeks to identify the optimal method for debriefing delivery and effect on patient outcomes.
authors.affiliation: Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, MIDRU Building, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK. Keithcouper@googlemail.com
authors.forename: Keith
authors.initials: K
authors.lastname: Couper
authors.forename: Bilal
authors.initials: B
authors.lastname: Salman
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Soar
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
mesh_terms: D003422:Critical Care / Q000592:standards*; D016638:Critical Illness; D004638:Emergency Treatment / Q000592:standards*; D005246:Feedback; D006801:Humans; D016896:Treatment Outcome