In this episode, we welcome back guest host Dr. Neelou Weeker and ED nurse Leigh Clary to talk about a tough emergency medicine reality that we often avoid discussing: what teamwork looks like when, despite our best efforts, the patient doesn’t survive. We work though a recent, emotionally heavy resuscitation and explore how TeamSTEPPS tools—specifically the structured debrief—serve as a vital safety net for our own mental health, helping us find our footing and reclaim our humanity in a chaotic environment.

The Reality of “Doing Everything Right” and Still Losing

We often connect good teamwork with saving lives, but in the ED, bad outcomes sometimes happen. The true test of a team’s culture is how we handle the aftermath of those tough cases.

1. The Emotional Roller Coaster of the ED

The “Would-Have, Could-Have, Should-Haves”: When a patient comes in talking and dies in the ED, it carries a heavy psychological weight for everyone and we often replay these cases over and over in our minds.
Flipping the Switch to Withdrawal of Care: Putting your heart and soul into a long resuscitation, getting pulses back, and then having to pivot and make the decision to withdraw care is an exhausting emotional shift for the whole team.
The Illusion of the Robot: The ED forces us to “code switch” instantly—moving from declaring a death straight to treating a minor complaint. Without a moment to pause, you start to feel like a robot, which takes a signficant toll on your wellbeing.

2. The Anatomy of a High-Quality Debrief

Debriefing after a tough case should be a priority, not a luxury. A solid debrief balances a clinical review with immediate psychological first aid.

Component	Standard Protocol & Best Practices
The Core Purpose	Framed around three pillars: Education, Quality Improvement, and Emotional Processing.
The Tone	Strictly confidential, safe, and non-punitive. It is explicitly stated at the outset that the session is not for assigning blame.
The Location	Ideally a quiet, isolated space physically removed from the immediate clinical chaos (a “doc box” or dedicated staff room).
The Leadership	Facilitated by designated Debrief Champions. If unavailable, any comfortable team member can step up.
The Attendees	Open to everyone who was involved in or affected by the case, including physicians, nurses, techs, students and scribes.

The Power of Prioritization: The emergency department is chronically busy, but a culture of safety means charge nurses actively shuffle staff and adjust coverage to carve out the 10 to 15 minutes required for a team to debrief.

Applying TeamSTEPPS to Team Longevity

1. The Need for a Clinical Respite

Data shows that the most important thing for a clinician after a bad outcome is just a brief break from the clinical area to regroup and compose themselves. Since we physically can’t just leave the ED to get a breath of fresh air, a structured debrief acts as that necessary “bubble” outside of active patient care.

2. Modeling Vulnerability as Leaders

To move away from the expectation that healthcare workers must act as emotionless automatons, leaders must intentionally model healthy processing.

Visible Humanity: When Attendings and nurse leaders show vulnerability and admit that a case hit them hard, it builds a culture where it’s okay to not be okay.
Creating “Fence Posts”: We can’t carry the weight of every patient we lose on our backs and still function. Structured debriefs allow us to package the experience into a “fence post” of clinical learning, honoring the patient while protecting the provider’s mental health.

Key Takeaways

De-Link Teamwork from the Outcome: Perfect teamwork can’t always override catastrophic pathology. Evaluate the team’s performance based on coordination, communication, and execution, not solely on whether the patient survived.
Establish a Standard Debrief Script: Protect your team by starting every post-event huddle with a reminder that the space is confidential, educational, and completely non-punitive.
Invest in Your Team: Implementing a formal debrief infrastructure requires minimal resources and builds team morale and resilience. (Pro-tip: bring candy to engage all the senses in a sensory reset!)

Do you use TeamSTEPPS or a similar model in your ED? We’d love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com

Host:

Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis

Guest Host:

Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis

Guest:

Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis

Resources:

TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica

TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN.

TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality

EM Pulse: TeamSTEPPS, September 17, 2021

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Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Disclaimer: The opinions expressed on this podcast are those of the hosts or guests and do not necessarily reflect the views of UC Davis Department of Emergency Medicine, UC Davis Health, or their parent organizations.