CICO documentation, debriefing and psychological safety

cico debriefing documentation psychological safety Jan 29, 2026

CICO Documentation, debriefing and psychological safety 

Clinicians know that “Can’t Intubate Can’t Oxygenate” (CICO) events are among the most frightening and consequential moments in airway management — rare, high-stakes, and emotionally charged. Debriefing after such critical events plays a vital role in learning, system improvement and emotional processing, but its effectiveness depends on three interconnected elements: clear documentation, structured debriefing, and psychological safety for all team members.

When we talk about documentation after a CICO event, it’s more than just recording facts. Good documentation captures key decision points, timing of interventions, team communication and deviations from expected protocols. This provides a reliable record to inform quality improvement work and reduces ambiguity in future discussions about what happened and why.

Debriefing gives teams the opportunity to reflect together on the event — what went well, what didn’t, and how systems or behaviours might change to improve future outcomes. Concept analyses of clinical debriefing emphasise that effective debriefing is purposeful, involves an experienced facilitator, attends to the environment and emotions of participants, and includes a structured evaluation phase. Debriefing can strengthen collaboration and shared learning across disciplines.

Psychological safety — the shared belief that team members can speak up without fear of embarrassment or punitive responses — is essential for honest, meaningful debriefing. When psychological safety is present, clinicians are more likely to admit uncertainty, ask questions and explore errors without defensiveness. This safe environment helps learning conversations flourish and supports emotional wellbeing after distressing events. Debrief facilitators can build psychological safety by setting clear expectations, using inclusive language, demonstrating respect, and being attentive to both verbal and non-verbal cues.

Together, thorough documentation, well-guided debriefing and intentional cultivation of psychological safety transform critical event review from a tick-box activity into a powerful driver of team performance, individual learning and compassionate clinical practice.

Build Knowledge ✅

Improve Safety ✅

References:

  1. Bowditch, L., Molloy, C., King, B., Abedi, M., Jackson, S., Bierbaum, M., Yu, Y., Raggett, L., Salmon, P., Braithwaite, J., Westbrook, J.I., Clay-Williams, R., Lingam, R., Middleton, S., Magrabi, F., Mumford, V. & Hibbert, P. (2025). Do patient safety incident investigations align with systems thinking? An analysis of contributing factors and recommendations. BMJ Quality & Safety. Published Online First: 12 September 2025. doi:10.1136/bmjqs-2025-019063.
  2. Toews, A.J., Martin, D.E. & Chernomas, W.M. (2021). Clinical debriefing: A concept analysis. Journal of Clinical Nursing, 30(11-12), pp.1491-1501. doi:10.1111/jocn.15636.
  3. Kolbe, M., Eppich, W., Rudolph, J., et al. (2020). Managing psychological safety in debriefings: A dynamic balancing act. BMJ Simulation & Technology Enhanced Learning, 6(3), pp.164-171. Published 20 April 2020. (Available via PMC: PMC8936758).

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