Implementation of the TALK Clinical Self-Debriefing Tool in Operating Theatres: A Single-Centre Interventional Study

Academic Background

The operating theatre is a complex and high-risk environment where teams need to adhere to safety behaviors to ensure optimal patient outcomes. Clinical debriefing is a recognized element of safe practice in the operating theatre, allowing clinicians to reflect on daily practices, learn, and improve. Although debriefing has been widely acknowledged for enhancing team performance and patient outcomes, it is still not a routine practice in operating theatre environments. Previous studies have identified barriers to debriefing, including lack of time and structure, conflicting priorities, insufficient leadership, and inadequate organizational support.

To address these issues, TALK (Talk to Learn and Improve Together) was introduced as a simple and widely applicable team self-debriefing method. TALK aims to promote team learning and improvement through daily debriefing conversations, emphasizing learning from everyday practices rather than solely from errors. This study aimed to explore changes in team behavior and the consideration and performance of debriefing after the introduction of the TALK tool in the operating theatre environment.

Source of the Paper

This paper was co-authored by Cristina Diaz-Navarro, Iago Enjo-Perez, Esther Leon-Castelao, Andrew Hadfield, Jose M. Nicolas-Arfelis, and Pedro Castro-Rebollo. The authors are affiliated with Cardiff and Vale University Health Board (UK), Universitat de Barcelona (Spain), Hospital Clinic Barcelona (Spain), and Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS, Spain). The paper was published on July 29, 2024, in the British Journal of Anaesthesia.

Research Process

Study Design

This was an interventional study designed to explore changes in team behavior after the introduction of the TALK tool in the operating theatre environment. The study was conducted at the University Hospital of Wales in the UK over 18 months. The primary objective was to evaluate the impact of the TALK tool on the consideration and performance of debriefing.

Study Participants

The study included 460 surgical lists, covering elective surgeries from Monday to Friday. Each surgical list was performed by the same team in the morning, afternoon, or throughout the day. The team typically consisted of at least one surgeon, two scrub nurses, one theatre assistant, one anesthetist, and one anesthetic assistant. Emergency surgical lists were excluded due to frequent changes in team composition.

Intervention

The introduction of the TALK tool involved four steps: 1) establishing a discussion target; 2) analyzing the discussion theme; 3) identifying learning points; and 4) agreeing on key actions to improve and maintain patient care. The research team promoted the TALK tool through various methods, including informal discussions with teams, email communications, standardized training sessions, and the provision of cognitive aids (e.g., posters and cards).

Data Collection and Analysis

Data were collected before the intervention and at 1 week, 3 months, 6 months, 12 months, and 18 months post-intervention. The research team conducted structured interviews with surgical teams using a questionnaire to assess compliance with the “Five Steps to Safer Surgery,” particularly focusing on the consideration and performance of debriefing. Data analysis was performed using chi-square and Fisher’s tests for non-parametric data.

Key Findings

Consideration and Performance of Debriefing

Before the intervention, 35.6% of teams considered debriefing, which significantly increased post-intervention, peaking at 97.4%. The performance of debriefing also increased from 23.3% at baseline to 39% at 6 months. However, after 6 months, the performance of debriefing declined but remained above baseline levels.

Improvement Actions During Debriefing

After the intervention, the number of improvement actions agreed upon during debriefing significantly increased, from 17.6% at baseline to 70% at 6 months. The scope of these improvement actions expanded from equipment optimization to communication, team efficiency, and shared decision-making.

Barriers to Debriefing

The primary barrier to debriefing was “lack of issues to discuss,” accounting for over 85% of cases. Other barriers included time constraints and lack of engagement. Post-intervention, barriers to debriefing significantly decreased.

Team Composition and Leadership

After the intervention, the involvement of nurses and allied healthcare professionals in debriefing significantly increased, with these groups taking a more active role in initiating and leading debriefing sessions.

Conclusion

This study demonstrated significant changes in team behavior following the introduction of the TALK tool in the operating theatre environment, particularly in the consideration and performance of debriefing. Although the performance of debriefing declined after 6 months, it remained above baseline levels. The introduction of the TALK tool promoted team engagement in debriefing and increased the proportion of improvement actions agreed upon during debriefing.

Research Highlights

1. Significant Increase in Debriefing: The introduction of the TALK tool significantly increased the consideration and performance of debriefing.
2. Expansion of Improvement Actions: The scope of improvement actions agreed upon during debriefing expanded to include communication, team efficiency, and shared decision-making.
3. Increased Involvement of Nurses and Allied Healthcare Professionals: Post-intervention, nurses and allied healthcare professionals played a more active role in initiating and leading debriefing sessions, breaking traditional hierarchical gradients.

Significance and Value of the Study

This study provides empirical support for the introduction of the TALK tool in the operating theatre environment, demonstrating its potential to promote team learning and improvement. The simplicity and broad applicability of the TALK tool make it easy to implement in other healthcare settings. Additionally, the study highlights the important role of nurses and allied healthcare professionals in debriefing, offering new insights for future team collaboration and patient safety improvements.

Future Research Directions

Future research could explore how reinforcement interventions can sustain the performance of debriefing and assess the long-term impact of debriefing on patient outcomes. Additionally, studies could extend to emergency and cardiac surgery teams to validate the applicability of the TALK tool in different surgical environments.

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Through this study, the TALK tool has demonstrated its potential to promote team learning and improvement in the operating theatre environment, offering a new tool and approach for future patient safety enhancements.