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Role of Briefing and Debriefing in Running Surgical Ward Round Effectively

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eMediNexus    23 December 2022

A surgical ward round (SWR) reviews all in-patients admitted electively for investigation, an operation, or acute surgical admissions. Various measures to enhance the effectiveness of SWR have been proposed with variable success. 

 

Since briefing and debriefing may improve the outcomes in the operation theatre, their effectiveness may also be explored for SWR. The introduction of the same style of briefing and debriefing may also improve the quality of SWR, causing an improved safety of the surgical patients. 

 

The present observational pilot study sought to improve patient safety by introducing briefing and debriefing in running the SWR effectively, which emphasized an optimum collaboration between rounding surgical team members. 

 

The study employed the WHO checklist in operation theatre to improve patient safety and its application in SWR settings. It prospectively collected data for six consecutive on-call weeks (42 days) and targeted round experience by all team members. It conducted briefing and debriefing just before and after the SWR and collected data regarding-

 

  • Characteristics of briefing and debriefing- duration and content
  • Subjective feedback from surgical Team members-positive and constructive
  • Objective features of SWR duration and missed patients

 

The study found-

 

  • The General and upper GI surgical team consisted of 5.57 (3-9) members per SWR per day over 42 days, including a consultant, registrar, SHO, F1, clinical assistant, and medical students. 
  • One thousand five hundred six patient review episodes on both new admissions and old in-patients. 
  • The mean SWR duration was 168.92 minutes. 
  • Mean briefing and debriefing time was 6.85 minutes and 6.71 minutes, respectively. 
  • The number of wards visited in SWR was 12.85/day. 
  • Briefing variables comprised of team introduction, the role of each member, round route, and triaging. 
  • Debriefing variables comprised of things that went well during SWR and areas that demanded improvement to run effective SWR. 
  • The SWR appeared organized and systematic, with better teamwork. 
  • No patients were missed from SWR during the study period. 
  • Clinical assistant absence caused the prolonged duration of SWR due to their vital role of updating surgical patient lists, identifying the surgical patients in different hospital wards, and providing results of all investigations.
  • The Team experienced- Better teamwork, Organized sessions of clinical work, Systematic approach to ward round, improved workflow with Job allocation and delegation, Involvement of all team members such as clinical assistant and medical students, Effective work style, Improved safety, Juniors felt supported, Positive feel for transient members, Awareness about team member work limitations, Job delegation by a consultant, Better training for clinical assistants and juniors, improved team efficiency by Jobs delegation as per team member skills, reduced stress and workload on juniors following Job delegation by consultants, feeling of involvement and positive by all team members for transient members of the surgical Team.

 

These findings indicate that the introduction of briefing and debriefing in the conduction of SWR significantly improves the team climate and the efficiency of the work with adequate duration per briefing and debriefing. Utilizing SWR augmented by pre-round briefing and post-round debriefing may be an effective and innovative tool to improve patient safety.

 

Sajid MS, Shafique S, Malik AM, Swaminathan C, Sains P, et al. (2022) Role of Briefing and Debriefing in Running Surgical Ward Round Effectively: A Prospective Observational Study. Int J Surg Res Pract 9:141. doi.org/10.23937/2378-3397/1410141

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