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Hospitals Huddle for Safety

Back Row: L to R - Theresa Coleman, Vivien Salmon, Dr. Dion David, Adrian Llewlyn, Teekema Clarke, RN
Front Row: L to R - Gilbert Maldonado, Maria Scaramuzzino, RN, Marlene Dacken, RN

The Trauma Emergency Department (ED) team members at Woodhull Hospital huddle in the morning, they huddle in the afternoon, and they huddle in the evening, too. Their "coach" makes the call to gather in a tight circle, and just like a sports team they begin to plan their next play for patient safety.

"I'm huge on huddles," said Dr. Maurice Wright, Chairman of Emergency Medicine at Woodhull Hospital, who inspires his fellow team members to achieve success by using huddles to share information about a patient, respond to a changing situation in the ED, ensure they have the resources they need to get the job done, or simply say, "good work."

"We huddle to clarify team roles and responsibilities, resolve conflict, and eliminate barriers to quality and safety for our patients," added Dr. Wright.

Across the country, at Madigan Army Medical Center in Tacoma,Wash., Dr. Peter Napolitano, Colonel, US Army Medical Corps, also likes to huddle. His team of Army surgeons in Iraq used the technique to achieve high levels of performance and save lives, which earned him a Bronze Star.

A popular method used to strategize and motivate, huddles have been adopted by Army medical teams and now by HHC hospitals across the city to improve communications and produce highly effective teams. The use of huddles is part of the scientifically proven teamwork system called TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) developed by the Department of Defense, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), to help healthcare professionals optimize the use of information, people and resources, and achieve the best clinical outcomes for patients.

"Huddles are a key strategy for medical team members to update their situational awareness, to quickly delegate tasks and responsibilities, all resulting in the whole team sharing one mental model on what's going on. With this simple, quick, 30-second ad hoc meeting, teams can do truly amazing things" said Colonel Napolitano, who was guest speaker at the HHC TeamSTEPPS Leadership Conference last month.

Woodhull Hospital began adopting the TeamSTEPPS principles in 2008 to address some of their major areas of concern: patient flow, wait times, walkouts and complaints. By March 2010, the trauma team had reduced the time between triage to physician assessment from a high of about 160 minutes to an all-time low of 40 minutes.

"The flow of patients from triage to disposition is tremendously improved even with the significant increase in the number of patients now being seen." said Adrian Llewellyn, Chief Physician Assistant at Woodhull Hospital and Dr. Wright's right hand in the ED.

They also saw a significant increase in patient satisfaction scores for key areas: doctor ratings, time in ER, helpfulness of the visit, and overall rating.

"More satisfied patients -- that's our Bronze Star," said Dr. Wright.

In addition to huddles, TeamSTEPPS directs providers to use other specific ways to communicate, including briefings, debriefings, and techniques called S-BAR (Situation, Background, Assessment, Recommendation) and CUS -- which helps individual members of the team to come forward and state that they are Concerned, Uncomfortable, and recognize the situation is a Safety issue.

More than 5,100 HHC employees have been trained on the principles of TeamSTEPPS and more trainings are underway.


August 2010

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