Chapter 5 Using Huddles

SAFE Programme Background Children in the UK experience higher morbidity and mortality than those in comparable health systems. Figure: Comparison of five year average mortality in childhood in European countries and excess deaths in UK (relative to comparator countries) according to method of first access to medical care, 2003-7 World Health Organisation Regional Office for Europe. European Detailed Mortality Database. www.euro.who.int/en/what-we-do/data-and-evidence/databases/european-detailed-mortality-database-dmdb2. Why the difference? Frequent failure to recognise the severity of illness Variable skill sets Inappropriate response to deterioration Poor communication Variable engagement with patients and parents

A Framework for Improvement Structure + Process +Culture = Outcome *Added to Donabedian’s original formulation by R. Lloyd and R. Scoville. Donabedian, A. (1966). "Evaluating the quality of medical care." Milbank Memorial Fund Quarterly 44(3): Suppl:166-206.

Cincinnati Children’s Hospital Key Driver Diagram Key driver diagram illustrates the drivers (at right) that would lead to aim through improved situation awareness and no unrecognized clinical deterioration. A KDD for the programme will be developed within the collaborative. Brady P W et al. Pediatrics 2013;131:e298-e308 ©2013 by American Academy of Pediatrics

What is Situation Awareness Thanks to Steve Meuthing

Learning from latest evidence

The Cincinnati Children Hospital Model Identify, mitigate, and escalate model illustrates which risk factors were systematically identified and how standardized communication about risk occurred throughout the centre. CCHMC has delivered an outcome of a nearly 50% decrease in unsafe transfers to higher levels of care and serious outcomes. The model will be revised in collaboration with the sites to suit the local requirements, as well as the needs of the different ward types. Additionally, the intervention will be given a new name, to differentiate from other ‘huddle’ techniques already in use. Brady P W et al. Pediatrics 2013;131:e298-e308 ©2013 by American Academy of Pediatrics

Outcome measure – transfers to ICU Brady P W et al. Pediatrics 2013;131:e298-e308

Situation Awareness Identify via SA Mitigate Escalate Perception Comprehension Projection

The ‘huddle’ suite to achieve SA Escalate Leaders Daily Safety Brief Overview of events of harm and risk Mitigate Ward Safety Huddle Nurses, Doctors, Allied professionals PEWS, Watchers, family or communication concern Identify Ward Bedside huddles Nurse Doctor Parent

Situation Awareness Responsibilities Individual Integrate clinical data into action Team Every team member understands the role in responding to data Shared Degree the team shares the same SA Distributed Dynamic awareness wider than the team Adapted from Brady et al

Using Huddles

Components of a Huddle Preparation Location People Culture Individuals aware of situation in areas of responsibility Location Suitable place for the huddle People Representation from whole MDT Culture Open approach to communication Valuing everyone’s input

Huddles and Quality Improvement The Cincinnati model is for one hospital. Through S.A.F.E, the core concepts have been developed using PDSA cycles into a wide range of different ways to huddle. Each works for its own setting. Use the information provided in previous chapters to find a solution that works for you.

Huddle Trigger Tool and Script To support the huddle, some sites use different tools: Trigger tools Used to identify, in advance of a huddle, which patients need to be discussed. The resource pack includes an example from Birmingham Scripts Acts as an aide memoire to ensure huddles follow a consistent format, helping reliable use

Drug-gle S.A.F.E encourages innovation and development. Taking the concepts and developing new interventions. The Watford Drug-gle is medications safety huddle – the poster is provided in the pack – and it has spread rapidly across the programme.

Huddle Reflection Tool

Huddle Reflection Tool Used to undertake a regular assessment of the quality of a huddle. Can be used to assess progress Can be used frequently as part of PDSA cycles Can be used less frequently to assess reliability and adoption