Implementation of a Structured Hot Debrief Tool in a Metropolitan ED: A Quality Improvement Study

To evaluate the acceptability and feasibility of implementing a structured 'hot debrief' tool, and its impact on team effectiveness, staff well-being and identification of system-level issues following critical events in two EDs.

We conducted a multi-site quality improvement study across two metropolitan Australian EDs from 2023 to 2025. A standardised hot debrief process was implemented following predefined critical events, with senior staff trained as facilitators. Staff perceptions were assessed using anonymous pre-, post- and final-implementation surveys, with quantitative data analysed descriptively. Completed debrief proformas from two 6-month trial periods were analysed using reflexive thematic analysis to identify recurring themes related to team function, well-being and system issues.

A total of 46 hot debriefs were conducted. In the final survey, 60 of 121 respondents (50%) had attended at least one debrief in the preceding 6 months. Amongst attendees, 98% reported that debriefs created a psychologically safe space, and 59 of 60 found them useful overall. Likert-scale responses indicated high perceived value, with most rating debriefs four or five out of five for team building, learning, issue identification and emotional processing. Thematic analysis identified five key system-level issues: interdepartmental communication, medication dosing in rare events, staffing and handover pressures, staff safety during behavioural emergencies and environmental and crowd-control challenges.

A structured hot debrief tool was feasible and well accepted. It supported team reflection, staff well-being and identification of recurrent system issues. Further research is needed to assess sustainability and downstream impacts on staff well-being and patient safety.