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Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project
  1. Max Sugarman1,2,
  2. Blair Graham1,
  3. Sarah Langston3,
  4. Pam Nelmes1,
  5. John Matthews3
  1. 1 Nursing and Midwifery, University of Plymouth, Plymouth, UK
  2. 2 Manchester Medical School, The University of Manchester, Manchester, UK
  3. 3 Whiston Hospital Emergency Department, St Helens and Knowsley NHS Trust, Liverpool, UK
  1. Correspondence to Max Sugarman, Nursing and midwifery, University of Plymouth, Plymouth, UK; max.sugarman{at}


Hot debriefing (HoD) describes a structured team-based discussion which may be initiated following a significant event. Benefits may include improved teamwork, staff well-being and identification of learning opportunities. Existing literature indicates that while staff value HoD following significant events, it is infrequently undertaken in practice. Internationally, several frameworks for HoD have been developed, although none are widely adopted for use in the ED. A quality improvement project was conducted to introduce HoD into a single UK ED in North West England, between January and March 2019. Following stakeholder consultation, the 9-item ‘TAKE STOCK’ tool was developed. Implementation of the tool increased the number of HoD (0—2.2 HoD episodes/week). Findings from the first plan-do-study-act (PDSA) cycle are presented, which revealed the key strengths and limitations of this model. Staff perceptions of the tool were evaluated using a self-administered short questionnaire designed by the authors. Satisfaction with TAKE STOCK was assessed using 10-point numerical scales. Across respondents (n−15), average satisfaction scores exceeded 9 out of 10 concerning patient care, staff self-care, decision-making, education, teamwork and identification of equipment issues. Implementation of HoD into the ED is feasible and viewed as beneficial by staff. Implementation toolkits for TAKE STOCK have been requested by 42 additional UK hospitals and ambulance trusts, demonstrating significant interest in its use. Research is now required to formally validate HoD frameworks for use in the ED, and assess whether HoD results in sustained improvements to staff and patient outcomes.

  • major incidents
  • clinical care
  • psychology
  • staff support
  • major trauma management
  • paediatrics
  • paediatric emergency medicine

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  • Handling editor Simon Smith

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  • Correction notice This article has been corrected since its publication. The authors wish to make it clear that the Take Stock tool was adapted from STOP5. The methods have been updated to clearly reflect this.

  • Contributors MS conceived the idea for the project, derived the TAKE STOCK tool, led implementation of the project, undertook data collection and analysis, drafted the initial manuscript and revised all subsequent versions. BG contributed to idea for the project, advised on implementation of the project, assisted data analysis, draft of the initial manuscript and revised all subsequent versions. SL contributed to the idea for the project, supervised implementation of the project and provided review of all versions of the manuscript. PN contributed to the idea for the project and provided review of all versions of the manuscript. JM contributed to the idea for the project, supervised implementation of the project and provided review of all versions of the manuscript.

  • 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 MS was awarded the 2019 Royal College of Emergency Medicine Undergraduate Prize for this work.

  • 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.

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