Specific examples of how debriefing has helped
improve outcomes and safety on the unit are numerous
and range from simple to complex. An
example of a simple problem involved the transfer
of the patient from the labor room to the operating
room (OR) table to perform a dilation and
curettage for a suspected retained placenta. The
debriefing revealed that the unit did not have the
correct stirrups in the OR and needed a reliable
system to ensure that correct stirrups are always
available. The unit’s scrub technicians assumed
the responsibility to develop this system.