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We’ve long been advocates of huddles in healthcare. Not just pre-op huddles and post-op debriefings, but also huddles in a variety of healthcare settings. For example, we advocate a huddle at the beginning of a clinic or office session. That helps plan the day’s activities and allow for contingencies. Similarly, we like a huddle at the end of the day to take a look at tomorrow’s clinic or office schedule. See our December 9, 2008 Patient Safety Tip of the Week “Huddles in Healthcare” for examples of various huddle opportunities in healthcare.
But the mid-shift huddle is a new one for us. Yet it makes a whole lot of sense. A recent article in Health Leaders (Davis 2021) discussed how mid-shift huddles at University of Wisconsin Health improved care for fall-risk patients and provided other benefits.
At University of Wisconsin Health the mid-shift huddles occur three times per day (once per shift) at 10:30 AM, 5 PM, and 3 AM. The care team leader leads these huddles and they are attended by the staff working that shift. While the initial focus was on patient safety, they subsequently added informational content.
The article discusses how the mid-shift huddles differ from the more typical change-of-shift huddles. The change-of-shift huddles provide a high-level overview of what staff need to know to successfully start their shift, such as unit status (census, open beds, admits/discharges), staffing, and safety concerns (code status, high fall-risk patients/recent falls, patients of concern). They also cover cover quick unit or organizational updates that don't need much discussion but are helpful to know, such as updates to the visitor policy, PPE changes, or workflow updates related to COVID.
The mid-shift huddles go into more detail regarding unit status, include more detail on high fall-risk patients, and check in with each staff member to redistribute resources if anyone needs help. These huddles last closer to 15 minutes and cover topics that need more in-depth discussion, such as a practice changes, lessons learned from recent healthcare-associated infections events on the unit, or educational content. In addition to including educational content, they sometimes add fun activities to the mid-shift huddles.
The article also notes positive experience with mid-shift huddles at Johns Hopkins Bayview (Buckingham 2018). The team on a surgical unit added mid-shift huddles to their existing use of the “huddle board”, a way of visually presenting data on ongoing projects. The mid-shift huddles were added as a way of reviewing each shift in real-time, looking backward and forward. But they quickly realized these huddles were great team building exercises. All staff attend the huddle, led by members of the management team, and other members of the interdisciplinary care teams are invited as well. They share not only clinical details and census data, but also staffing updates, announcements, and congratulations. They found these mid-shift huddles helped them improve fall rates, hand hygiene compliance, staff responsiveness (on the HCAHPS report), staff engagement, and improvements in both the Safety Climate and Teamwork domains.
Another very logical venue for mid-shift huddles would be the emergency department. Rather than waiting for end-of-shift to prepare handoffs to incoming staff, it makes sense to plan well ahead of time for change of shift. For example, a mid-shift huddle could help expedite moving an admission to an actual inpatient bed rather than leaving that task to incoming staff. That mid-shift huddle can also alert staff to incoming patients (either transfers from other facilities or in-transit ambulance patients).
The biggest challenge for mid-shift huddles, according to Sara Schoen, nurse manager at University of Wisconsin Health, is balancing the time to attend huddles against any time being taken away from patient care. Our own take on this balancing act is that any mid-shift refocusing of resources can likely minimize any care left undone and be beneficial in the long run. The added benefit on team building and staff morale is a real bonus whose value you simply can’t measure.
See our prior columns on huddles, briefings, and debriefings:
Davis C. Huddle Up! Nursing Mid-Shift Meetings Create Better Outcomes. HealthLeaders 2021; June 21, 2021
Buckingham B. Huddling for Healthcare. In 2017-2018 Johns Hopkins Bayview Nursing Annual Report. Creating a Highly Reliable Organization. Johns Hopkins Medicine 2018
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