Background
Debriefs/huddles in healthcare
Debriefs/huddles and safety culture
Debriefs/huddles and perceptions of teamwork
Methods
Sample and procedure
Hospital bed size, mean (SD) | 26 (6) |
Total number of falls (Range across 16 hospitals) | 347 (5–49) |
Total number of unique patients who fell (Range across 16 hospitals) | 308 (4–43) |
Total number of falls followed by a post-fall huddle | 223 |
Total proportion of falls followed by a post-fall huddle (Range across 16 hospitals) | 0.64 (0.29–0.96) |
Repeat fall rate, mean (Range) | 1.12 (1.00–1.45) |
The post-fall huddle intervention
Measures
Repeat fall rate
TeamSTEPPS® teamwork perceptions questionnaire (T-TPQ)
Dimensions and Items
|
Post-Fall Huddle Participation
|
p value
| |
---|---|---|---|
Yes
(n varies 256 to 266)
a
|
No
(n varies 440 to 472)
a
| ||
Team Structure (α = .92) | 92 | 90 | .63 |
1. The skills of all hospital staff overlap sufficiently so that work related to fall-risk-reduction can be shared when necessary. | 92 | 91 | .62 |
2. All hospital staff are held accountable for their actions related to fall-risk reduction. | 87 | 89 | .49 |
3. Staff within my unit/department share information that enables timely decision making about fall-risk reduction by the direct patient care team. | 95 | 89 |
.009
|
4. My unit/department makes efficient use of resources related to fall-risk reduction (e.g., staff, supplies, equipment, information). | 94 | 92 | .37 |
5. Staff within my unit/department understand their roles and responsibilities related to fall-risk reduction. | 95 | 95 | .77 |
6. My unit/department has clearly articulated goals for fall-risk reduction. | 93 | 86 |
.003
|
7. My unit/department operates at a high level of efficiency when it comes to fall-risk reduction. | 91 | 88 | .29 |
Leadership (α = .96) | 91 | 82 |
<.001
|
1. My supervisor/manager considers staff input when making decisions about fall-risk reduction. | 93 | 86 |
.01
|
2. My supervisor/manager provides opportunities to discuss the unit/department’s performance after a patient fall. | 91 | 78 |
<.001
|
3. My supervisor/manager takes time to meet with staff to discuss the fall-risk-reduction program. | 88 | 74 |
<.001
|
4. My supervisor/manager ensures that adequate resources (e.g., staff, supplies, equipment, information) are available to support the fall-risk-reduction program. | 92 | 88 |
.09
|
5. My supervisor/manager successfully resolves conflicts involving the fall-risk-reduction program. | 87 | 81 |
.04
|
6. My supervisor/manager models appropriate team behavior in support of the fall-risk-reduction program. | 92 | 87 |
.06
|
7. My supervisor/manager ensures that staff are aware of any situations or changes that may affect the fall-risk-reduction program. | 91 | 83 |
.004
|
Situation Monitoring (α = .89) | 90 | 87 | .26 |
1. Staff effectively anticipate each other’s needs when implementing fall-risk-reduction interventions. | 92 | 88 |
.08
|
2. Staff monitor each other’s performance when implementing fall-risk-reduction interventions. | 84 | 82 | .60 |
3. Staff exchange relevant information to decrease the risk of falls as it becomes available. | 94 | 91 |
.08
|
4. Staff continuously scan the environment for important information to decrease the risk of falls. | 93 | 90 |
.02
|
5. Staff share information regarding potential complications that may increase a patient’s risk of falls (e.g., change in status, previous fall). | 95 | 91 |
.07
|
6. Staff meet to reevaluate a patient’s fall-risk-reduction plan of care when aspects of the situation have changed. | 88 | 82 |
.049
|
7. Staff correct each other’s mistakes to ensure that fall-risk-reduction procedures are followed properly. | 84 | 84 | .96 |
Mutual Support (α = .92) | 89 | 87 | .42 |
1. Staff assist fellow staff to decrease the risk of falls during a high workload. | 93 | 91 | .24 |
2. Staff request assistance from fellow staff to implement fall-risk-reduction interventions when they feel overwhelmed. | 91 | 93 | .47 |
3. Staff caution each other about potentially dangerous situations that may increase the risk of patient falls. | 94 | 93 | .54 |
4. Feedback between staff about fall-risk reduction is delivered in a way that promotes positive interactions and future change. | 90 | 88 | .30 |
5. Staff advocate for patients who are at risk for falls even when their opinion conflicts with that of a senior member of the unit/department. | 90 | 90 | .98 |
6. When staff have a concern about a patient’s risk of falling, they challenge others until they are sure the concern has been heard. | 84 | 80 | .24 |
7. Staff resolve their conflicts about fall-risk reduction, even when the conflicts have become personal. | 82 | 76 |
.07
|
Communication (α = .94) | 92 | 90 | .24 |
1. Information about fall-risk reduction is explained to patients and their families in lay terms. | 95 | 91 |
.06
|
2. Staff relay relevant information about fall-risk reduction in a timely manner. | 95 | 92 | .18 |
3. When communicating with patients about fall-risk reduction, staff allow enough time for questions. | 93 | 92 | .63 |
4. Staff use common terminology when communicating with each other about fall-risk reduction. | 96 | 94 | .15 |
5. Staff verbally verify information about a patient’s fall risk that they receive from each other. | 93 | 90 | .23 |
6. Staff follow a standardized method of sharing fall risk information when handing off patients. | 89 | 87 | .44 |
7. Staff seek fall-risk-reduction information from all available sources. | 84 | 85 | .96 |
Hospital survey on patient safety culture (HSOPS)
Dimensions and Items
|
Post-Fall Huddle Participation
|
p Value
| |
---|---|---|---|
Yes
(n varies 218 to 221)
a
|
No
(n varies 357 to 368)
a
| ||
Overall perception of Safety (α = .92) | 76 | 76 | .83 |
1. Patient safety is never sacrificed to get more work done. | 72 | 75 | .50 |
2. Our procedures and systems are good at preventing errors from happening. | 82 | 79 | .40 |
3. It is just by chance that more serious mistakes don’t happen around here.b | 76 | 71 | .16 |
4. We have patient safety problems in this department.b | 75 | 79 | .27 |
Frequency of Events Reported (α = .97) | 70 | 66 | .48 |
1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? | 58 | 58 | .93 |
2. When a mistake is made, but has no potential to harm the patient, how often is this reported? | 70 | 63 |
.09
|
3. When a mistake is made that could harm the patient, but does not, how often is this reported? | 81 | 77 | .17 |
Supervisor/Manager Expectations & Actions Promoting Patient Safety (α = .92) | 83 | 80 | .88 |
1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures. | 73 | 74 | .70 |
2. My supervisor/manager seriously considers staff suggestions for improving patient safety. | 85 | 81 | .25 |
3. Whenever pressure builds up, my supervisor/ manager wants us to work faster, even if it means taking shortcuts.b | 88 | 83 |
.10
|
4. My supervisor/manager overlooks patient safety problems that happen over and over.b | 84 | 82 | .43 |
Organizational Learning—Continuous Improvement (α = .86) | 85 | 79 |
.10
|
1. We are actively doing things to improve patient safety. | 96 | 91 |
.03
|
2. Mistakes have led to positive changes here. | 77 | 71 |
.08
|
3. After we make changes to improve patient safety, we evaluate their effectiveness. | 83 | 74 |
.01
|
Teamwork Within Departments (α = .92) | 87 | 85 | .63 |
1. People support one another in this department. | 91 | 92 | .80 |
2. When a lot of work needs to be done quickly, we work together as a team to get the work done. | 94 | 94 | .94 |
3. In this department, people treat each other with respect. | 85 | 81 | .17 |
4. When one area in this department gets really busy, others help out. | 77 | 74 | .35 |
Communication Openness (α = .90) | 64 | 63 | .88 |
1. Staff will freely speak up if they see something that may negatively affect patient care. | 78 | 79 | .89 |
2. Staff feel free to question the decisions or actions of those with more authority. | 52 | 46 | .16 |
3. Staff are afraid to ask questions when something does not seem right.b | 63 | 64 | .74 |
Feedback and Communication About Error (α = .84) | 69 | 68 | .71 |
1. We are given feedback about changes put into place based on event reports. | 61 | 56 | .27 |
2. We are informed about errors that happen in this department. | 68 | 71 | .50 |
3. In this department, we discuss ways to prevent errors from happening again. | 79 | 78 | .69 |
Nonpunitive Response to Error (α = .87) | 64 | 56 |
.05
|
1. Staff feel like their mistakes are held against them.b | 70 | 63 |
.07
|
2. When an event is reported, it feels like the person is being written up, not the problem.b | 69 | 56 |
<.001
|
3. Staff worry that mistakes they make are kept in their personnel file.b | 54 | 49 | .17 |
Staffing (α = .96) | 73 | 69 | .31 |
1. We have enough staff to handle the workload. | 76 | 70 | .14 |
2. Staff in this department work longer hours than is best for patient care.b | 61 | 58 | .59 |
3. We use more agency/temporary staff than is best for patient care.b | 80 | 78 | .52 |
4. We work in “crisis mode” trying to do too much, too quickly.b | 73 | 68 | .27 |
Hospital Management Support for Patient Safety (α = .92) | 83 | 80 |
.10
|
1. Hospital management provides a work climate that promotes patient safety. | 93 | 89 | .13 |
2. The actions of hospital management show that patient safety is a top priority. | 83 | 81 | .48 |
3. Hospital management seems interested in patient safety only after an adverse event happens.b | 73 | 69 | .35 |
Teamwork Across Hospital Departments (α = .88) | 75 | 66 |
.011
|
1. There is good cooperation among hospital departments that need to work together. | 76 | 67 |
.02
|
2. Hospital departments work well together to provide the best care for patients. | 86 | 76 |
.003
|
3. Hospital departments do not coordinate well with each other.b | 62 | 52 |
.02
|
4. It is often unpleasant to work with staff from other hospital departments.b | 77 | 67 |
.01
|
Hospital Handoffs and Transitions (α = .96) | 61 | 52 |
.07
|
1. Things “fall between the cracks” when transferring patients from one department to another.b | 59 | 50 |
.04
|
2. Important patient care information is often lost during shift changes.b | 63 | 50 |
.003
|
3. Problems often occur in the exchange of information across hospital departments.b | 60 | 50 |
.03
|
4. Shift changes are problematic for patients in this hospital.b | 63 | 57 | .15 |
Analysis
Results
Association between post-fall huddle prevalence and repeat fall rates
Association between post-fall huddle participation and perceptions of teamwork (Table 2)
-
two of seven items in the Team Structure dimension (e.g., “My unit/department has clearly articulated goals for fall-risk reduction”).
-
the Team Leadership dimension (e.g., “My supervisor/manager provides opportunities to discuss the unit/department’s performance after a patient fall”).
-
two of seven items in the Situation Monitoring dimension (e.g., “Staff meet to reevaluate a patient’s fall-risk-reduction plan of care when aspects of the situation have changed”).
Association between post-fall huddle participation and perceptions of safety culture (Table 3)
-
two of three items in the Organizational Learning dimension (e.g. “After we make changes to improve patient safety, we evaluate their effectiveness”),
-
one reverse-worded item within the Nonpunitive Response to Error dimension (e.g. “When an event is reported, it feels like the person is being written up, not the problem”),
-
the Teamwork Across Hospital Departments dimension (e.g. “Hospital departments work well together to provide the best care for patients”), and
-
three of four reverse-worded items within the Hospital Handoffs and Transitions dimension (e.g. “Important patient care information is often lost during shift changes”).