1. Chapter 5 Using Huddles

2. 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, World Health Organisation Regional Office for Europe. European Detailed Mortality Database.
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

3. 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:

4. 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

5. What is Situation Awareness
Thanks to Steve Meuthing

6. Learning from latest evidence

7. 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

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

9. Situation Awareness Identify via SA Mitigate Escalate Perception
Comprehension
Projection

10. 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

11. 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

12. Using Huddles

13. 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

14. 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.

15. 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

16. 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.

17. Huddle Reflection Tool

18. 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