Implementing a Cold Debrief Program in the Emergency Department: A Framework for Reflection and System Improvement

The aims of debriefing can be diverse and may include psychological support, departmental quality improvement or an educational focus. There has been increased attention on 'hot debriefs', however, competing clinical and departmental demands can limit the ability of response teams to meaningfully reflect on critical cases. 'Cold debriefs' are a delayed form of debriefing, occurring days to weeks after the critical event. This article reflects on the implementation of a cold debriefing model within a tertiary emergency department in Australia utilising Lewin's Theory of planned change. Over a 12-month period, 16 referrals for cold debriefs were received, of which 11 were selected to proceed to a formal debrief, with all clinical and non-clinical staff involved in the critical event invited to participate. A standardised and reproducible framework was introduced for facilitators to ensure psychological safety. By offering a cold debriefing process for specific critical events, cold debriefs not only support the clinical team but may also harness opportunities for systems improvement. Ensuring the sustainability of the Cold debrief program required integration and familiarisation within the emergency department, building a stable pool of facilitators and providing remuneration for participants attending outside of rostered work hours.