Huddling Improves Situational Awareness among Hospital Staff and Leaders

Implementing a system of huddles can provide systematic and regular opportunities for microsystem-, mesosystem-, and macrosystem-level leaders and others to interact face-to-face to examine and solve problems together, according to the results of a study published online June 6, 2013, in BMJ Quality and Safety. The study, which took place at an academic tertiary care children’s hospital with 539 inpatient beds, developed and tested an interrelated tiered huddle system to improve the ability of staff and administration to identify emerging risks and threats, place those events in the proper organizational context, and formulate specific predictions and plans to efficiently and effectively resolve them. The researchers incorporated principles of situational awareness into the huddle system by asking each participant to systematically report on patients on their unit who they thought may deteriorate in the near future and label them as “watchers” (perception); asking senior nurses and physician leads to coach charge nurses on how to integrate their perceptions into an informal severity-of-illness assessment (comprehension); and training the clinicians on how to use the information to facilitate prediction and planning for at-risk patients (projection).