Debriefing in Physician-Staffed Helicopter Emergency Medical Services: A Quality Improvement Study

In Norway, physician-staffed helicopter emergency medical services (HEMS) provide critical care for patients needing advanced prehospital treatment. To measure the quality of care, 15 quality indicators (QIs) are monitored, including the occurrence of "debriefing," a discussion aimed at promoting communication, team learning, and safety. At Trondheim HEMS, the "debriefing" quality indicator has been identified as underperforming compared with other Nordic HEMS bases, suggesting missed opportunities for communication and learning. Given that human error is a major factor in adverse events both in medicine and aviation, enhancing debriefing practices may be crucial for improving quality and safety. The objective of this study was to assess the impact of two interventions on debriefing rates.

In this prospective quality improvement study at Trondheim HEMS, HEMS crews recorded debriefing occurrences in a QI database. The primary measure was the debriefing rate per shift, analyzed using statistical process control. Before the interventions, baseline data were collected in a 2-month period. The first intervention involved placing reminder posters in high-traffic areas. The second intervention provided feedback through a continuously displayed chart of debriefing performance, allowing crews to compare their rates to overall trends. Each intervention lasted 2 months, followed by washout periods where interventions were removed to evaluate sustained effects.

The first intervention had no significant improvement in debriefing rates. Notable variation between physicians was observed during the first intervention and washout period. The second intervention stabilized the process and increased the average debriefing rate from 58% in the baseline period to 71% during the intervention. This continued during the following washout period.

Prominent variation in performance between physicians indicates a lack of framework for debriefing to occur. The increased debriefing rate is still not ideal. Further approaches are needed to improve debriefing practices in the service.