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Systematic review of clinical debriefing tools: attributes and evidence for use
  1. Emma Claire Phillips1,2,
  2. Samantha Eve Smith1,
  3. Victoria Tallentire1,
  4. Sheena Blair2
  1. 1 Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
  2. 2 College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Emma Claire Phillips, The University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh EH16 4SB, UK; e.c.phillips{at}


Background and objectives Clinical debriefing (CD) following a clinical event has been found to confer benefits for staff and has potential to improve patient outcomes. Use of a structured tool to facilitate CD may provide a more standardised approach and help overcome barriers to CD; however, we presently know little about the tools available. This systematic review aimed to identify tools for CD in order to explore their attributes and evidence for use.

Methods A systematic review was conducted in line with PRISMA standards. Five databases were searched. Data were extracted using an electronic form and analysed using critical qualitative synthesis. This was guided by two frameworks: the ‘5 Es’ (defining attributes of CD: educated/experienced facilitator, environment, education, evaluation and emotions) and the modified Kirkpatrick’s levels. Tool utility was determined by a scoring system based on these frameworks.

Results Twenty-one studies were included in the systematic review. All the tools were designed for use in an acute care setting. Criteria for debriefing were related to major or adverse clinical events or on staff request. Most tools contained guidance on facilitator role, physical environment and made suggestions relating to psychological safety. All tools addressed points for education and evaluation, although few described a process for implementing change. Staff emotions were variably addressed. Many tools reported evidence for use; however, this was generally low-level, with only one tool demonstrating improved patient outcomes.

Conclusion Recommendations for practice based on the findings are made. Future research should aim to further examine outcomes evidence of these tools in order to optimise the potential of CD tools for individuals, teams, healthcare systems and patients.

  • Adverse events, epidemiology and detection
  • Communication
  • Decision analysis
  • Safety culture
  • Significant event analysis, critical incident review

Data availability statement

Data are available on reasonable request.

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  • Contributors ECP: conception and design of the work; data collection, analysis and interpretation; drafting and revising of the paper and approval of the final version of the manuscript for submission; guarantor responsible for overall content of the work. SES and VT: data collection; drafting and revising of the paper and approval of the final version of the manuscript for submission. SB: conception and design of the work; drafting and revising of the paper and approval of the final version of the manuscript for submission. All authors agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.