Perioperative Critical Incident Responses at a Major Trauma Center: Baseline Assessment, Adaptive Program Development, Implementation, and Evaluation

BACKGROUND: Clinical critical incidents in anesthesiology practice may adversely affect clinician well-being. Post-critical incident debriefing may support staff and patient safety. However, implementing programs in high-acuity environments remains challenging. We aimed to determine baseline post-clinical critical incident practices at our institution, develop and implement a context-adapted program, and evaluate its integration into practice and its impact. METHODS: We undertook a mixed-methods study. The baseline survey measured psychological safety, prior experiences with critical incidents, and debriefing practices. Focus groups deepened our understanding of key stakeholder needs. These findings informed the design of an adapted post-incident support program. A post-implementation evaluation using surveys and focus groups examined perceived impacts. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically to identify determinants of feasibility and acceptability, as well as contextual barriers. RESULTS: The baseline survey (N = 55/111; 50% response rate) generally demonstrated high psychological safety. Debriefing was a highly emotional experience, logistical barriers were common, and the purpose of debrief sessions was sometimes ambiguous. Following program refinement, duty relief after critical incidents increased (N = 10/37; 27% at baseline, N = 27/42; 64% post-program, χ 2 (1) = 10.97, P < .001 ) and most respondents reported feeling supported despite persistent logistical barriers to post-incident responses. Observed vulnerability in senior staff in post-incident support sessions was welcomed by trainees, but sometimes challenging for senior clinicians. Although critical incidents had negative impacts on respondents (N = 28/54, 52% professional and N = 20/54, 37% personal adverse impact), we also identified potential for post-traumatic professional growth (N = 26/54, 48% positive professional impact). CONCLUSIONS: Our stakeholder-informed, contextually adapted debriefing program was acceptable, feasible, and may mitigate the adverse effects of critical incidents while fostering professional growth. Persisting challenges included logistics, the tension between a well-being and clinical review focus, and differential risks and benefits by career stage.