COMMUNICATION IMPROVEMENT PROJECT: THE SHIFT HUDDLE ON THE PEDIATRIC ICU

Problem:  The pediatric intensive care unit (PICU) at UNMH is a dynamic environment.  The critical patient population and the ever-present possibility of new admissions and deteriorating patient conditions can make managing patient care and workflow challenging.  To handle these challenges and optimize patient outcomes, teamwork and communication among all members of the nursing staff must be present.  The current method of report between nurses and charge nurses has been an efficient way to “change the guard” in the PICU for many years.  However, staff communication has been a major PICU safety focus and we felt a layer of intra-shift communication would be beneficial for staff and patients.

Methods:  Our literature review showed that effective and increased communication is a vital part of a safe nursing environment.  The nursing quality report Keeping Patients Safe (2003) by the Institute of Medicine recommends a safety culture that employs “ongoing, effective, multidirectional communication.”  Based on our review we decided to launch daily, brief team meetings of all nursing staff.  These “huddles” would be a way to share information on critically ill patients, upcoming procedures or “travel” needs, and identify nurses who may need help with a busy assignment.

Results:  Literature review showed that this type of informational huddle format had been attempted only in clinics and surgical centers – not ICUs.  We encountered obstacles that were products of the critical care environment such as bedside procedures and high patient acuity.  We overcame these through trial and error with timing and location of huddles and by keeping huddles brief. 

Conclusion:   Overall, the huddle process has had a positive impact on PICU communication.  The huddles reflect the IOM’s directive calling for “ongoing, effective, multidirectional communication.”  Shift huddles have become a permanent part of the PICU communication matrix.

Nursing Implications:  The shift huddle has evolved in the PICU.  In addition to sharing vital patient information, the PICU leadership team and UBE use the huddle to briefly share important unit process and logistical information.  We find these “huddle points” to be more effective than just emailing information to staff.  Even with the addition of “huddle points”, we have been able to maintain the horizontal – staff nurse to staff nurse – feel of the daily shift huddle. 

Reference:

Institute of Medicine. (2003).  Keeping patients safe: Transforming the work of nurses.

 

            Washington, DC: National Academies Press.