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Huddle Up!

In a football game, the action usually doesn’t begin until both teams huddle up to call the right play. The same thing should happen in hospital operating rooms and ambulatory surgery centers (ASCs).

An OR or ASC huddle is a quick gathering of personnel to review and discuss cases that are scheduled for the day and any issues that might affect them. Ideally, huddles should take place at the beginning of each workday and last no more than 10 to 12 minutes.

Why Huddle Up?

According to Deb Yoder, MHA, BSN, RN, CNOR, director of clinical operations and compliance officer with Surgical Management Professionals in Sioux Falls, S.D., daily morning huddles allow teams to get the perioperative area organized and make sure they have easy access to whatever will be helpful to the team. “Setting a time limit is helpful to get everyone going and not delay the day,” she says. 

“The morning huddle is not the place for catchup, complaints and gossip,” Yoder adds. “It’s the place to share useful information in an efficient manner with everyone.”

Jamie Ridout, RN, MSN, MBA, NEA-BC, CNOR, CASC, the administrator for Capital City Surgery Center in Raleigh, N.C., says there are different definitions of a daily huddle and these huddles can have different purposes.

“For our center, the daily huddle is intended to be a quick gathering to review and discuss any issues that may have occurred on the day of the huddle, as well as a review of the surgery schedule for the coming week,” says Ridout. “The purpose is to look at various areas − such as staffing, equipment and supply needs and constraints, and the surgery schedule − and any pre-op or post-op concerns.”

“The huddle needs to be scheduled on a regular basis and start on time,” says Jeffrey Keane, BSN, RN, CNOR, unit based educator, west campus operating room, perioperative services, for Beth Israel Deaconess Medical Center in Boston, Mass. “Those attending need to know that everyone’s time is valuable and will be respected.”

Keane believes in a multidisciplinary approach to huddles where each discipline can share the status of their team. “These huddles need to be quick, concise and have a defined leader,” he says. “If any conversation is getting long-winded the leader can ask for it to be resumed offline at the end of the huddle. This allows the huddle to be completed within 10 minutes or so.”

Trina E. Ingalls, MSN, RN, the CEO of DISC Surgery Center in Newport Beach, Calif., agrees with Keane about taking a multidisciplinary approach to huddles. 

“We conduct multi-departmental huddles one or two times a week due to the complexity of our caseload,” she says. “During these huddles we review our caseload for the upcoming week to ensure we have all angles covered.”

These multi-departmental huddles are in addition to daily huddles that only include members of the clinical team.

“During our daily huddles we review cases for the following day and perform a rundown of staffing assignments, including what trays, supplies and implants are being used,” says Ingalls. “We also review any special equipment or turnover needs to keep the day flowing safely.” 

“Daily huddles are quick, no more than five to 10 minutes,” Ingalls adds. “Everyone remains standing and it is an ‘all-speak-up’ event.”

Yoder distinguishes between daily morning huddles and huddles to regroup after an event so everyone can decompress. “These types of huddles are different in nature and need, but both are very important,” she says. 

Structuring Your Huddles

Todd Masten, the founder and COO of SurgeryDirect in Salt Lake City, Utah, uses what he calls the three S’s when structuring daily huddles: Standardized, Succinct and Standing.

“Standardized means having an agenda and sticking to it,” says Masten. “This helps keep the meeting in flow and allows for two-way communication. Our huddles are not orations − they are conversations.”

Masten points to studies indicating that the average attention span is no more than 20 minutes, which makes keeping huddles succinct critical. “Therefore, our daily huddles are 10 to 12 minutes long at the most,” he says. “Being succinct is a learned trait that only gets better over time.”

Finally, Masten believes that making staff just a little uncomfortable (but not in a negative way) by having them remain standing is important so everyone wants to finish the meeting. “When people sit down, it’s easy to drag things out,” he says. “Rarely does this happen with standing meetings, though.”

Masten describes the huddle process at SurgeryDirect: “The team starts by talking through preoperative, PACU and then the OR with any add-ons or scheduled case reviews and any potential issues like known allergies or same last name patients. Then, we talk through any patient satisfaction or quality data and let everyone know about any additional critical information before opening up discussion to the staff for any of their concerns.”

Erin Keeney, MSN, RN, CNOR, director of perioperative services for Anmed Health in Anderson, S.C., agrees with Masten about the importance of standardizing huddles. “We have five-minute huddles daily at 7 a.m., 1 p.m. and 3 p.m.,” she says. “The first and second shift huddles at 7 a.m. and 3 p.m. are for the charge RNs and staff, while the 1 p.m. huddle is for all of perioperative leadership.”

Keeney stresses the importance of explaining the “why” of huddles to staff and leadership so everyone is on board. “Make your huddles informative and brief and allow staff to engage and express issues they may see for the current day or the next day,” she says. “Also keep the huddle in the same location every day.”

“Huddles are intended to be a quick meeting to share pertinent information,” says Ridout. “I believe huddles should have a consistent structure and an operational focus with the goal of communication, preparedness and ultimately patient safety.”

Ridout offers a few more suggestions for structuring your huddles:

  • Set an expectation of attendance.
  • Stick to a consistent agenda and template.
  • Leave time for discussion, if needed.
  • Be predicable and consistent.
  • Follow up on any issues that are uncovered.
  • Be brief and be gone.

Yoder says that any unique patient concerns that are not in the medical record can be communicated during a huddle, as well as any pending needs. “For example, maybe the implants for a case are arriving late and will need to be reprocessed,” she says. “Or maybe SPD is down a staff member today.”

Keane says that his team uses the daily huddle to discuss any work needing to take place in the perioperative area that will affect normal operations. “This is especially important before a weekend since resources can be limited during this time,” he says.

“I also think it’s important for staff to get the information from the huddle so they are aware of what is happening around them,” Keane adds. “We have a daily huddle report form that is sent each day after the huddle.”

At DISC Surgery Center, different team members are selected to lead the huddle discussion each day. “This promotes an environment where it’s natural for everyone to feel comfortable providing information and feedback regarding the following day,” says Ingalls.

Benefits of Huddling Up

Ridout says the benefits of having daily huddles far outweigh any drawbacks. These include: 

  • Greater patient safety
  • Fewer medical errors
  • Better team communication 
  • Greater staff and physician satisfaction 
  • More staff accountability

“The bottom line is that having daily huddles elevates the quality of care delivered to patients,” says Ridout.

Keane believes that the main benefit of daily huddles is informing each department what is happening so they can start to develop priorities for the day. “This gets everyone on the same page to start the day and begin to work on the most important tasks,” he says.

Huddles also present an opportunity to discuss instrument concerns, equipment conflicts, vendor information, staff communication and safety reviews. “Staff can create a plan each day for how the day will be structured and how to deal with any changes that might come up,” says Keeney.

Obstacles to Huddling Up

If there are so many benefits to daily huddles, then why don’t they occur in every hospital OR and ASC? Unfortunately, there are also a number of obstacles that can hinder the practice of huddling. 

“Probably the biggest challenge is finding time to prepare for the huddle and determining the best time of the day so all can attend,” says Ridout. “It takes time to prepare for the huddle when everyone’s day is already busy, and the huddle can even lead to more ‘to-do’s’ for some staff.”

Sometimes huddles can be repetitive so engagement can be challenging. “And to be honest, not everyone feels they are necessary,” says Ridout.

Early case starts, emergent cases, poor timing, lack of staff involvement and huddles that run too long are other potential obstacles to huddling listed by Keeney.

Masten says there are always competing priorities that can make it easy not to huddle up. “There’s always an excuse,” he says. “We have removed excuses and made huddling up a priority.”

“The biggest obstacle we face is having a time when all team members can come together,” says Ingalls. “With cases being conducted, it’s difficult on some days to communicate with everyone at the same time. We utilize a white board and have key points written on it for those who miss the daily huddle.”

Ridout believes that the majority of ASCs are not huddling consistently and effectively. “I think ASCs are still evolving into these types of practices and perhaps still establishing internal shared governance and quality assurance programs,” she says. “The size of the ASC can also be a factor − a one- or two-room single specialty ASC may not see the need.”

Overcoming Obstacles to Huddling

The best way to overcome these and other obstacles is for leadership to stress the importance of huddling up.

“Leadership can spearhead the initiative by stressing the importance of huddling to improve communication and increase patient safety,” says Ridout. “In ASCs, the environment is small enough that the director of nursing and/or administrator can be directly involved in the process.”

“Leaders must be consistent in holding huddles despite these barriers and obstacles,” says Ingalls. “They should also educate the team about the patient safety aspects of huddles and make sure there’s a standing agenda so the huddle moves quickly and efficiently.”

Keeney encourages leadership to meet with perioperative teams to explain the “why” behind daily huddles. “When there are issues that arise, all members of the perioperative team can come together to ensure that proper measures are in place to prevent future issues,” she says.

Yoder believes that the key to successful huddling is making sure that there’s value for everyone involved. “If the staff doesn’t think huddling is valuable, they won’t attend,” she says. “Or even worse, they’ll make it a negative experience for everyone else.” 

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