Morning Briefings and Huddles

1. Morning Briefings and Huddles Elizabeth Martinez, MD, MHS Michael Rosen, PhD

2. Comprehensive Unit-based Safety Program (CUSP) • Educate staff on science of safety • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools • Pre-Operative Daily Huddle (OR) • Morning Briefing (ICU and Floor)

3. 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 Armstrong Institute for Patient Safety and Quality

4. THE BASICS OF BRIEFINGS Armstrong Institute for Patient Safety and Quality

5. Situation Awareness: An Overview • 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. 5

6. Briefing Defined A Briefing is a discussion between two or more people, often a team, using succinct information pertinent to an event. • What a briefing immediately does: • Maps out the plan of care • Identifies roles and responsibilities for each team member • Heightens awareness of the situation • Allows the team to plan for the unexpected • 5. Allows team members’ needs and expectations to be met 6

7. 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) Armstrong Institute for Patient Safety and Quality

8. 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 8

9. PRE-OPERATIVE DAILY HUDDLE FOR THE OPERATING ROOM Armstrong Institute for Patient Safety and Quality

10. 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 Armstrong Institute for Patient Safety and Quality

11. 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 Armstrong Institute for Patient Safety and Quality

12. 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 Armstrong Institute for Patient Safety and Quality

13. 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 Armstrong Institute for Patient Safety and Quality

14. 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 Armstrong Institute for Patient Safety and Quality

15. Huddle Process Armstrong Institute for Patient Safety and Quality

16. THE MORNING BRIEFING FOR ICU AND FLOOR SETTINGS Armstrong Institute for Patient Safety and Quality

17. Who Participates • The Physician doing rounds who is responsible for the ICU patients that day • The Night Charge Nurse • The Day Charge Nurse 17

18. Morning Briefing Process Three simple questions: • What happened overnight that I need to know about? • Where should I begin rounds? • Do you anticipate any potential defects in the day? 18

19. 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? Armstrong Institute for Patient Safety and Quality

20. 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? 20

21. 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? 21

22. 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 22

23. 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. 23

24. Status of Safety Issues (Cusp Manual, Appendix E) Unit:___________________________________ Armstrong Institute for Patient Safety and Quality

25. SUMMARY COMMENTS Armstrong Institute for Patient Safety and Quality

26. Why briefings? • Teams perform better when… • They have a high quality plan • They share the plan • Briefings can help, but they do not guarantee good planning. • ‘Checking the box’ ≠ mindful engagement Armstrong Institute for Patient Safety and Quality

27. 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 Armstrong Institute for Patient Safety and Quality

28. 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 • Make an opening statement to set a non-threatening tone • State the concern or problem • Offer a potential solution • Come to agreement about the problem and solution Armstrong Institute for Patient Safety and Quality

29. Comprehensive Unit-based Safety Program (CUSP) • Educate staff on science of safety • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools • Pre-Operative Daily Huddle (OR) • Morning Briefing (ICU and Floor)

30. 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 Armstrong Institute for Patient Safety and Quality