IN A TEAM HUDDLE, a unit's staff comes together at the beginning of a shift and quickly discusses patient concerns, safety issues, and updates. Huddles may include the unit's nurses, unlicensed assistive personnel, attending healthcare providers, social workers, physical therapists, respiratory therapists, case managers, occupational therapists, and speech therapists.

Although huddles are similar to hospital-wide interdisciplinary rounding in that patient safety is discussed, team huddles differ by focusing on only one unit's patients. These huddles are dedicated to improving the quality of the patient stay by using all active healthcare professionals to resolve any issues that may delay the patient's discharge. Whether the patient needs a neurology consult, physical therapy evaluation, assistance with breathing treatments from the respiratory team, or medication teaching from the nurse, the healthcare team can tackle these points early in the day so that patients can be discharged in a timely, efficient, and safe manner.

The huddle differs from a team meeting in that it's a brief, daily discussion focusing on the plan of action for the shift ahead. It isn't centered on workflow issues but instead promotes discussion among coworkers regarding patient safety and goals of care.1

The daily huddle can help promote optimal patient outcomes. Taking the time to come together to communicate about patients improves awareness of the general state of the unit and decreases chaos caused by poor communication. Problems that may have been overlooked can be discussed quickly and may be resolved in a short time, allowing the number of safety alerts to gradually decrease and the amount of effective discharges to increase.2 This article describes how an organized team huddle can help staff plan a productive and safe workday for all members of the healthcare team.

Leader of the team

The charge nurse or nurse manager is usually responsible for leading the huddle, but in some facilities a clinical nurse specialist or someone else has this role. He or she reviews the huddle sheet that details patient circumstances, including the risk of falls and pressure injuries and the presence of transmission-based precautions, high-alert medications, indwelling urinary catheters, and central venous access devices.3

The charge nurse may be designated as the huddle leader to establish continuity. Functioning as the huddle leader enhances the nurse's organizational, team-building, and leadership skills.1 Team huddle leaders set the standard for efficiency and teamwork by establishing guidelines for patient discussion and information sharing. (See Setting huddle goals.)

During the patient review, healthcare team members should be alerted about particular areas of caution, such as fall risk, needed for safe patient care. Patient needs such as discharge instructions and scheduled procedures can be reviewed and the workload for the shift can be assessed. This provides an additional opportunity for the charge nurse to determine if any patient assignments are too heavy and also to identify opportunities for adjustment throughout the day to improve efficiency.

Key players

Teamwork is an essential part of creating an efficient workday. The unit charge nurse coordinates the availability of all team members. Failure of multiple team members to participate may impair communication among those caring for the patient, prolonging the patient's hospital stay. Involving all members of the team allows them to address patient needs from the perspective of many disciplines.1 Nurses should use this time to make each other aware of what's needed from other team members, such as healthcare provider orders and physical therapy evaluations.

Nonnursing team members will also benefit from the huddles. Obtaining pertinent information from the other team members lets them develop a plan before entering the patient's room.4 For example, a physical therapist may share that a physical therapy evaluation revealed that a patient can't recover his or her prehospitalization baseline function. This then allows the attending hospitalist to change the discharge disposition and recommend the patient be discharged to an inpatient rehabilitation facility rather than to home. In turn, this affects the social worker, who can now start finding suitable rehabilitation options for the patient instead of trying to organize a discharge to home. The patient now has a tailored plan of care and an expedited and appropriate discharge plan, thanks to effective communication between the physical therapist, hospitalist, and social worker.

All in the timing

Establishing a routine on the unit is important. Participants come together at the nurses' station each day at the same time. Consistency of location and time emphasizes the significance of the huddle in providing the highest level of effective care.

Although huddles needn't be time-consuming, they should last long enough for clinicians to review all necessary patient components in a timely manner to facilitate productivity for the shift ahead. It's the huddle leader's responsibility to keep the huddles short, focused, and on-task, ensuring each necessary topic is discussed.1 Establishing a predetermined time to meet during each shift lets healthcare staff anticipate the concerns to address in that day's huddle.5

Focus on patient safety

Huddles help nurses prioritize patient care and focus on patient safety. They provide the opportunity to discuss any safety events that have occurred, how the event happened, and how to prevent recurrences.

Participating in the huddle gives nurses the opportunity to review pertinent patient issues and to plan for variations or problems that can occur throughout the shift. If a patient needs a new medication, requires a different route of administration, or would like to see a different member of the healthcare team, this is the time and place to share this information.

When the huddle is finished, team members can evaluate its success and follow up as necessary. (See Evaluating the huddle.)

Positive effects

Patients find that communicating with a cohesive team is much easier than trying to deal with multiple individuals walking in and out of their room on separate occasions.6 Effective communication between healthcare workers and patients can lead to shorter patient stays, increased patient satisfaction, improved flow of information, and more effective patient interventions.6

Patient safety starts with teamwork. Huddles impact the entire team's approach to providing care by emphasizing the value of each coworker in contributing to the care to all patients.4 After discussing patient problems as a team, staff members know that patient safety is a shared responsibility and that they're not alone in developing a safe and effective plan.4

Knowing that communication with the collaborating provider has occurred right from the beginning of the shift gives nurses peace of mind. Huddling also reduces interruptions later in the day because any concerns have been clarified immediately in the meeting.7 This means additional time can be spent with patients, facilitating the environment for a strong nurse-patient relationship.

Win-win situation

Incorporating team huddles in the daily routine can make all the difference to a patient's hospital experience and to the healthcare team's workday. Nurses who make it a part of their routine may find they have smoother workdays and less stress all around.

Setting huddle goals8

* Improve patient outcomes.

* Reduce falls and clarify safety concerns.

* Individualize the plan of care for each patient.

* Clearly discuss patient-specific daily goals.

* Identify barriers to progress, discharge, or transfer.

* Ensure all proper services are in place before discharge.

* Communicate any unit-specific operational issues such as shortages of supplies or changes in policies.

Evaluating the huddle

* Are team members clear about their responsibilities for the patient?

* Are appropriate tests being ordered and completed?

* Is the team clear about what needs to be accomplished before the patient is discharged?

* Have personalized goals been identified for the patient?

* Have safety risks been assessed and modified?

* Have patient and family concerns been addressed?

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