Introducing ‘Hot’ debrief tool post cardiac arrest calls in Northwick Park Hospital and London North West University Healthcare NHS Trust (STAR-5-FULL)

Introduction
In-hospital cardiac arrests (1–1.5 per 1,000 UK admissions) are highly stressful, particularly for junior staff. Although national and international guidelines recommend post–cardiac arrest debriefing, implementation remains inconsistent, with rates between 6–31%. Debriefs—derived from military and aviation practices—support reflective learning, team performance, emotional wellbeing, and system improvement. They may be “hot” (immediate) or “cold” (delayed), each with benefits and risks. Reflective medicine theory underpins debriefing as a process promoting learning, team reflexivity, and a shift from blame to improvement culture. This Quality Improvement (QI) project aimed to innovate, develop and evaluate a structured “hot” debrief tool—STAR-5-FULL—to enhance reflection, learning, and wellbeing after cardiac arrest events.

Method
Conducted at London North West University Healthcare NHS Trust (Northwick Park Hospital), the STAR-5-FULL tool (“Situation, Things went well, Addressing concern, Review learning, 5—in five minutes, Follow-up, Learning & Leadership”) was adapted from the STOP5 framework. Adult cardiac and peri-arrest events were included if debriefed by ≥2 staff members. Implementation used QR-coded electronic recording, simulation workshops, and promotional activities via newsletters, screensavers, and induction sessions. Data were analysed thematically every three months, with findings shared for governance feedback.

Results
A pre-implementation survey (n=20) found 55% had participated in debriefs and all agreed they improved practice. Main themes included promoting staff-wellbeing, and non-blame culture, while time and training were key barriers. Since launch in September 2024 till April 2026, 37 debriefs were completed, with engagement ranging from 2.6% to 23.7%. Themes included leadership, communication, resources, and training needs.

Recommendations
Key actions included regular review of patient escalation-plans documentation, enhanced echocardiography training, simulation-sessions for doctors, clear debrief-leadership role allocation in cardiac arrest huddles, improved access to and familiarity with resuscitation equipment and medications, and collaboration with the resuscitation team. Workshops improved facilitator confidence and engagement. Sustainability requires leadership support, protected time, and a psychologically safe, learning-focused culture to improve staff wellbeing and patient safety.