In brief
- Debriefings can improve patient care, but they need to be properly structured and focused on learning to reduce medico-legal risks for participants.
- Information shared during a debriefing may be protected from disclosure in a legal proceeding, but this is not assured.
- A properly structured debriefing increases the likelihood that the information discussed will be protected in legal proceedings.
Properly structured debriefings that focus on learning and improvement may help teams to learn, adapt, and improve communication. However, some physicians may be reluctant to take part in debriefings out of concern that the information may be used in a legal proceeding. This concern should not stop physicians from participating in debriefings. The resulting advantages for patient care will often outweigh the risk of the information being used or disclosed in legal proceedings.
Disclose patient safety incidents
As a physician, you have an ethical, professional, and legal obligation to disclose patient safety incidents to your patients. If a patient safety incident occurs, you should always discuss the incident with patients to inform them of the facts. Debriefings should never interfere with or replace these discussions.
What are debriefings?
Debriefings are used to foster in-the-moment learning and team self-correction immediately after procedures or significant events (e.g. cardiopulmonary resuscitation, emergency C-section). Regardless of whether a procedure or event went well, debriefings offer an opportunity to continuously improve processes and team function.
Debriefings differ from morbidity and mortality (M&M) rounds, which are structured events where members of a department review cases more generically.
Improve the likelihood that debriefing information is protected
In civil litigation, all relevant information is generally admissible as evidence, but a court may rule that information shared during a debriefing is protected from disclosure. Such protection may be available when the debriefing meets certain criteria.
The following scenario illustrates how a court may approach a request to protect debriefing information.
An individual launches a legal action alleging they were harmed by the delivery of healthcare. During legal proceedings, the defendant healthcare providers and hospitals are asked to produce information about discussions or reviews they conducted after the care was provided. The defendants are giving evidence under oath and they acknowledge a debriefing was held. The court is then asked to rule on whether the defendants have to disclose information discussed and any conclusions reached during the debriefing.
In making its decision, the court would consider whether statutory or common law protection applies to the information. The court would look to such things as how the debriefing was structured, what was discussed, and whether there was an understanding among participants that the debriefing and related documentation would be kept confidential.
While there is no advance guarantee that debriefing information will be protected from disclosure, there are some things physicians working with their colleagues and facility can do to increase the likelihood of protection:
- Develop terms of reference and protocols for debriefings. Within these documents, clearly state that debriefings are for quality improvement purposes and participants must keep all information discussed confidential.
- Conduct debriefings in a setting that allows all information to be kept private.
- While routine debriefings are not usually documented, where information is collected it should be compiled under confidential cover and access should be limited to those listed in the terms of reference and protocols for debriefings.
- Seek advice from hospital legal counsel, the CMPA, or both before disclosing or discussing any feedback on the care provided by individual healthcare practitioners to other parties, for example patients or their families.
- Encourage hospital leadership or management to start a quality assurance review if a debriefing identifies issues requiring significant changes to systems or processes.
To advance a safe, respectful atmosphere where the debriefing participants feel free to speak openly and honestly, they should be reminded that debriefing objectives do not include criticizing the care of any healthcare team member or assigning blame. In addition to being counterproductive, critical, blaming comments can potentially have significant negative consequences for the defence in a legal proceeding.
Any treatment recommendations made during the debriefing about the patient’s ongoing care should be documented in the patient’s medical record.
Participating in Continuous Quality Improvement activities
The CMPA encourages physicians to participate in quality improvement activities that are created according to legislation protecting quality assurance records and information from disclosure.
While it is not always possible to have all quality assurance activities conducted by a formal and properly constituted quality assurance committee, the benefits of participating in quality improvement activities, when focused on learning and improving systems, outweigh the possible risks the information could be used or disclosed in subsequent legal proceedings.
Additional reading
