Team Huddles: a Winning Strategy for Safety by Priscilla Di Vincenzo, BSN, RN

PATIENT SAFETY

Team huddles: A winning strategy for safety By Priscilla Di Vincenzo, BSN, RN

IN A TEAM HUDDLE, a unit’s staff Problems that may have been over- and also to identify opportunities for comes together at the beginning of looked can be discussed quickly adjustment throughout the day to a shift and quickly discusses patient and may be resolved in a short time, improve efficiency. concerns, safety issues, and updates. allowing the number of safety alerts Huddles may include the unit’s to gradually decrease and the amount Key players nurses, unlicensed assistive person- of effective discharges to increase.2 Teamwork is an essential part of cre- nel, attending healthcare providers, This article describes how an orga- ating an efficient workday. The unit social workers, physical therapists, nized team huddle can help staff plan charge nurse coordinates the avail- respiratory therapists, case managers, a productive and safe workday for all ability of all team members. Failure occupational therapists, and speech members of the healthcare team. of multiple team members to partici- therapists. pate may impair communication Although huddles are similar Leader of the team among those caring for the patient, to hospital-wide interdisciplinary The charge nurse or nurse manager prolonging the patient’s hospital stay. rounding in that patient safety is is usually responsible for leading the Involving all members of the team discussed, team huddles differ by huddle, but in some facilities a clini- allows them to address patient needs focusing on only one unit’s patients. cal nurse specialist or someone else from the perspective of many disci- These huddles are dedicated to has this role. He or she reviews the plines.1 Nurses should use this time improving the quality of the patient huddle sheet that details patient cir- to make each other aware of what’s stay by using all active healthcare cumstances, including the risk of needed from other team members, professionals to resolve any issues falls and pressure injuries and the such as healthcare provider orders that may delay the patient’s dis- presence of transmission-based pre- and physical therapy evaluations. charge. Whether the patient needs cautions, high-alert medications, Nonnursing team members will a neurology consult, physical therapy indwelling urinary catheters, and also benefit from the huddles. Obtain- evaluation, assistance with breathing central venous access devices.3 ing pertinent information from the treatments from the respiratory The charge nurse may be desig- other team members lets them team, or medication teaching from nated as the huddle leader to estab- develop a plan before entering the the nurse, the healthcare team can lish continuity. Functioning as the patient’s room.4 For example, a physi- tackle these points early in the day huddle leader enhances the nurse’s cal therapist may share that a physical so that patients can be discharged in organizational, team-building, and therapy evaluation revealed that a a timely, efficient, and safe manner. leadership skills.1 Team huddle lead- The huddle differs from a team ers set the standard for efficiency and Setting huddle goals8 meeting in that it’s a brief, daily dis- teamwork by establishing guidelines • cussion focusing on the plan of for patient discussion and informa- Improve patient outcomes. • Reduce falls and clarify safety action for the shift ahead. It isn’t tion sharing. (See Setting huddle goals.) concerns. centered on workflow issues but During the patient review, health- • Individualize the plan of care for instead promotes discussion among care team members should be alerted each patient. coworkers regarding patient safety about particular areas of caution, such • Clearly discuss patient-specific 1 and goals of care. as fall risk, needed for safe patient daily goals. The daily huddle can help pro- care. Patient needs such as discharge • Identify barriers to progress, mote optimal patient outcomes. Tak- instructions and scheduled proce- discharge, or transfer. ing the time to come together to dures can be reviewed and the work- • Ensure all proper services are in communicate about patients load for the shift can be assessed. This place before discharge. • improves awareness of the general provides an additional opportunity Communicate any unit-specific state of the unit and decreases chaos for the charge nurse to determine if operational issues such as shortages of supplies or changes in policies. caused by poor communication. any patient assignments are too heavy www.Nursing2017.com July l Nursing2017 l 59

discussed.1 Establishing a predeter- with the collaborating provider has Evaluating the huddle mined time to meet during each shift occurred right from the beginning of • Are team members clear about their lets healthcare staff anticipate the con- the shift gives nurses peace of mind. responsibilities for the patient? cerns to address in that day’s huddle.5 Huddling also reduces interruptions • Are appropriate tests being ordered later in the day because any concerns and completed? Focus on patient safety have been clarified immediately in • Is the team clear about what needs Huddles help nurses prioritize the meeting.7 This means additional to be accomplished before the patient care and focus on patient time can be spent with patients, patient is discharged? • Have personalized goals been safety. They provide the opportunity facilitating the environment for a identified for the patient? to discuss any safety events that have strong nurse–patient relationship. • Have safety risks been assessed occurred, how the event happened, and modified? and how to prevent recurrences. Win–win situation • Have patient and family concerns Participating in the huddle gives Incorporating team huddles in the been addressed? nurses the opportunity to review per- daily routine can make all the differ- tinent patient issues and to plan for ence to a patient’s hospital experience patient can’t recover his or her prehos- variations or problems that can occur and to the healthcare team’s workday. pitalization baseline function. This throughout the shift. If a patient Nurses who make it a part of their then allows the attending hospitalist to needs a new medication, requires a routine may find they have smoother change the discharge disposition and different route of administration, or workdays and less stress all around. ■ recommend the patient be discharged would like to see a different member to an inpatient rehabilitation facility of the healthcare team, this is the time REFERENCES rather than to home. In turn, this and place to share this information. 1. Yu E. Implementing a daily team huddle. American Medical Association. 2016. https://www.stepsforward. affects the social worker, who can now When the huddle is finished, team org/modules/team-huddles. start finding suitable rehabilitation members can evaluate its success and 2. Sikka R, Kovich K, Stacks L. How every hospital options for the patient instead of try- follow up as necessary. (See Evaluat- should start the day. Harv Bus Rev. 2014. https://hbr. ing to organize a discharge to home. ing the huddle.) org/2014/12/how-every-hospital-should-start-the-day. 3. Lubinensky M, Kratzer R, Bergstol J. Huddle up The patient now has a tailored plan of for patient safety. Am Nurse Today. 2015;10(2). https:// care and an expedited and appropriate Positive effects americannursetoday.com/huddle-patient-safety/. discharge plan, thanks to effective Patients find that communicating 4. Frank J. Staff huddles boost communication, teamwork. Med Econ. 2011. http://medicaleconom- communication between the physical with a cohesive team is much easier ics.modernmedicine.com/medical-economics/ therapist, hospitalist, and social than trying to deal with multiple news/modernmedicine/modern-medicine-feature- articles/staff-huddles-boost-communica?page=full. worker. individuals walking in and out of 5. Institute for Healthcare Improvement. Use regu- 6 their room on separate occasions. lar huddles and staff meetings to plan production All in the timing Effective communication between and to optimize team communication. 2017. Establishing a routine on the unit is healthcare workers and patients can 6. O’Daniel M, Rosenstein AH. Professional communication and team collaboration. In: Hughes important. Participants come together lead to shorter patient stays, increased RG, ed. Patient Safety and Quality: An Evidence-Based at the nurses’ station each day at the patient satisfaction, improved flow of Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008. www. same time. Consistency of location information, and more effective patient ncbi.nlm.nih.gov/books/NBK2637/. and time emphasizes the significance interventions.6 7. Dingley C, Daugherty K, Derieg M, Persing R. Improving patient safety through provider commu- of the huddle in providing the highest Patient safety starts with teamwork. nication strategy enhancements. 2014. www.ahrq. level of effective care. Huddles impact the entire team’s gov/downloads/pub/advances2/vol3/advances- Although huddles needn’t be time- approach to providing care by empha- dingley_14.pdf. 8. Team rounds. 2015. Stanford Health Care. consuming, they should last long sizing the value of each coworker in https://stanfordhealthcare.org/health-care- enough for clinicians to review all contributing to the care to all patients.4 professionals/nursing/patient-care/team-rounds.html. necessary patient components in a After discussing patient problems as a Priscilla Di Vincenzo is an RN in the surgical ICU at timely manner to facilitate productivity team, staff members know that patient Strong Memorial Hospital in Rochester, N.Y. for the shift ahead. It’s the huddle safety is a shared responsibility and leader’s responsibility to keep the that they’re not alone in developing a The author has disclosed no ﬁ nancial relationships related to this article. huddles short, focused, and on-task, safe and effective plan.4 ensuring each necessary topic is Knowing that communication DOI-10.1097/01.NURSE.0000520522.84449.0e

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