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© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Morning Briefings and Huddles Elizabeth Martinez, MD, MHS Michael Rosen, PhD
© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011
Morning Briefings and Huddles
Elizabeth Martinez, MD, MHS
Michael Rosen, PhD
Comprehensive Unit-based Safety Program (CUSP)
1. Educate staff on science of safety
2. Identify defects
3. Assign executive to adopt unit
4. Learn from one defect per quarter
5. Implement teamwork tools – Pre-Operative Daily Huddle (OR)– Morning Briefing (ICU and Floor)
Learning Objectives
• Understand the fundamentals of briefings in teams
• Understand the purpose of the CUSP daily briefing tools
• Understand how to implement these tools in your area– Pre-operative daily huddle in the Operating
Room
– Morning briefing in the ICU and Floor
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THE BASICS OF BRIEFINGS
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• Members of the team have an understanding of “what’s going on” and “what is likely to happen next.”
• Teams are alert to developing situations, sensitive to cues and aware of their implications.
Situation Awareness: An Overview
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Briefing Defined
What a briefing immediately does: 1. Maps out the plan of care2. Identifies roles and responsibilities for each team
member3. Heightens awareness of the situation4. Allows the team to plan for the unexpected5. Allows team members’ needs and expectations to
be met
A Briefing is a discussion between two or more people, often a team, using succinct information
pertinent to an event.
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Effective Briefings
Set the tone for the day… chaotic versus organized and efficient
Encourage participation by all team members
Are ‘owned’ by all team members• Organized in thought regarding the procedure• Establishes competence: • Who has what skills• Who performs what• Who knows what• Predicts what will happen later• Plans for the unexpected(e.g., equipment, medications, consults)
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When to Conduct Briefings
• Beginning of the day - Morning Briefing
• Prior to any procedure in any setting
• Situational – change in patient status results in deviation from plan of care
• Reporting-off-breaks, change of shift
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PRE-OPERATIVE DAILY HUDDLE FOR THE OPERATING ROOM
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The Problem
• Scheduling surgical procedures is often complicated by:– unanticipated problems and obstacles– poor communication among anesthesiologists,
surgeons, resident/CRNA colleagues and nurses
• This inefficiency in patient care delivery wastes patient and provider’s time and increases stress for both parties
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What is a Pre-Op Daily Huddle?
• A dialogue between 2 or more people using concise and relevant information to promote effective communication prior to beginning patient procedures in the operating room suites
• An opportunity for all participants to voice concerns and address issues that will affect the quality of patient care delivery and patient flow
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Purpose of Tool
• To provide a structured process to assist the anesthesia coordinator and charge nurses in:– anticipating potential problems during the day– increasing efficiency of patient flow
• To allow the anesthesiology and OR nursing coordinators to readjust the OR schedule to ensure efficient and timely flow of patient care
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Who Should Use this Tool?
• Anesthesiologist/OR coordinators – who make staff assignments and plan for patient flow within
the Operating Room Suites
• OR Nurse Coordinators/Charge nurses – who make staff assignments and are responsible for patient
needs being met
• ICU staff – who use the OR schedule to triage ICU bed availability, as
well as identify other operations not posted for an ICU bed that may require one
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How to Use this Tool
• Complete this tool daily during a meeting between the Anesthesiologist OR coordinator and the OR Nursing Coordinator
• Can be completed in part the night before and finished the next morning and/or could be used prior to the start of the first morning case
• Major issues that involve significant delays/cancellations are communicated directly to the appropriate attending surgeon or other appropriate staff members no later than 07:00 by the Anesthesiologist OR coordinator
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Huddle Process
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THE MORNING BRIEFING FOR ICU AND FLOOR SETTINGS
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Who Participates
1. The Physician doing rounds who is responsible for the ICU patients that day
2. The Night Charge Nurse
3. The Day Charge Nurse
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Morning Briefing Process
Three simple questions:
1. What happened overnight that I need to know about?
2. Where should I begin rounds?
3. Do you anticipate any potential defects in the day?
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1. What Happened Overnight That I Need to Know About?
• You should be thinking about…– Was there adequate coverage?
– Were there any equipment issues?
– Were new cases posted to the ICU?
– Were there unexpected changes in patient acuity?
– Were there any adverse events?
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2. Where Should Rounds Begin?
• Is there a patient who requires my immediate attention secondary to acuity?
• Which patients do you believe will be transferring out of the unit today?
• Who has discharge orders written?
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As you continue planning rounds
• How many admissions are planned today?
• What time is the first admission?
• How many open beds do we have?
• Are there any patients having problems on an inpatient unit?
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3. Do You Anticipate Any Potential Defects in the Day?
• Patient scheduling
• Equipment availability/ problems
• Outside Patient testing/Road trips
• Physician or nurse staffing
• Provider skill mix
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When You Identify Defects / Problems
• Want to assign a person to the issue - have them follow up
• Identify actions taken to meet any patient or unit needs
• Report back to the staff what those actions were or will be
• If ongoing - continue to report it during morning briefing until it is resolved or alternatively use Appendix E Status of Safety Issues.
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Status of Safety Issues (Cusp Manual, Appendix E)
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New and OngoingDate Safety Issue Contact Status Goal
CompletedDate Safety Issue Contact Status Goal
Unit:___________________________________
SUMMARY COMMENTS
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Why briefings?
• Teams perform better when…1. They have a high quality plan
2. They share the plan
• Briefings can help, but they do not guarantee good planning.– ‘Checking the box’ ≠ mindful engagement
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How do you get a mindful process?
• Coaching, role modeling, and feedback– Show that the organization values this process– Build effective communication behaviors
• ‘Closing the loop’ with outcomes of the briefing process– E.g., defects identified and corrected– Establishes the validity (and utility) of the
process
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Effective communication in briefings
• Communication at transition points in care is often one-sided.
– Hesitancy to speak up and ask questions
• Use solution-focused assertiveness
1.Make an opening statement to set a non-threatening tone
2.State the concern or problem
3.Offer a potential solution
4.Come to agreement about the problem and solution
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Comprehensive Unit-based Safety Program (CUSP)
1. Educate staff on science of safety
2. Identify defects
3. Assign executive to adopt unit
4. Learn from one defect per quarter
5. Implement teamwork tools – Pre-Operative Daily Huddle (OR)– Morning Briefing (ICU and Floor)
Next steps
• Think about how these tools fit into your local context
• Get input from all stakeholders• Modify the tool to fit your needs• Pilot, revise, and implement
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