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Introduction: Poor organizational culture and communication problems are consistently identified as the primary root causes of perinatal death and injury[1]. Building a culture of safety in perinatal medicine starts with effective teamwork and communication[2]. Formation of effective teams in healthcare has become a national priority[3]. Debriefing after acute clinical events is a highly-regarded tool used for team building that has a positive impact on teamwork [4].  The development of a strong, structured debriefing program has the potential to increase both teamwork and overall communication among medical and nursing providers.

Program Development: As part of a robust Obstetric Safety Initiative, we recognized that timely interdepartmental and multidisciplinary debriefings after acute clinical events is a crucial part of team building. Our goal was to design an interdepartmental debriefing program that encourages interdisciplinary discussions in a non-threatening environment and identifies opportunities for systems-based and teamwork-based improvements. The second objective of the debriefing program, was implementation of systems-based and teamwork based opportunities for improvement which were identified during the debriefings. Implementation progress is tracked and communicated on a regular basis to frontline staff and departmental leadership. Several tools were developed for the debriefing program, including a tool to identify cases for discussion, a debriefing organization algorithm, the format for the debriefing process, and a tracking tool to follow our implementation progress.

Results: Since launching our debriefing program in July of 2007, we held nine interdepartmental debriefings and identified on average ten opportunities for improvement per debriefing. Approximately 60% of the identified areas for improvement have been resolved. We feel that the debriefing program has accelerated or work in developing a culture of safety both among our Obstetric providers and with outside services. This is reflected through improved provider responses on the Safety Attitude Questionnaire[5]. Staff were surveyed sixteen months apart. The percent of providers reporting a "good safety climate" increased from 68% to 79%, and the percent reporting a "good overall teamwork climate" from 58% to 72%.

Conclusion: Debriefing in healthcare still remains a primary component for cultural change. Regular interdisciplinary debriefing has the potential to accelerate the patient safety movement. This paper will provide a review of the process for debriefing an acute clinical event, including a tool to identify cases for discussion, a debriefing organization algorithm, the format for the debriefing process, and a tracking tool to follow our implementation progress.