The Surgical Safety Huddle: Novel Quality Improvement Patient Safety Initiative

Abstract

Background: Acutely deteriorating patients are entitled to the best possible care which includes early recognition and timely appropriate intervention to reduce adverse events, unnecessary admissions to intensive care and/or cardiac arrest. Aim: To reduce the number of poor outcomes for surgical patients with a National Early Warning Score (NEWS) score ≥7 in our institution by 50%. A poor outcome was defined as: 1. Cardiac arrest 2. NEWS >7 not improving after 72 hours 3. Transfer to ICU >6 hours Methods: Surgical inpatients from a variety of surgical specialties (general, vascular, breast, colorectal, hepatobiliary, and plastic surgery) in a large university teaching hospital were included. Quality improvement tools were used to generate regular dialogue with the clinical teams, resulting in the concept of the surgical safety huddle being proposed. Deteriorating patients were highlighted at the daily huddle and a plan of early intervention was implemented. An incremental approach with continuous PDSA [Plan- Do-Study-Act] cycles and subsequent feedback was adopted on the surgical ward to develop the huddle. Poor patient outcomes were analysed prospectively via chart reviews. Results: Prior to the introduction of the “surgical huddle” 110 patients with NEWS >7 were audited. Twenty-eight of these patients had a poor outcome at 72 hours (25%). Following the introduction of the surgical huddle supported by the deteriorating patient team, 64 patients with NEWS >7 were reviewed. Three of these patients had a poor outcome at 72 hours (4.7%). The introduction of the surgical huddle increased the interval between cardiac arrests more than sixfold on the surgical ward. Discussion: The introduction of the surgical safety huddle supported by the deteriorating patient response team reduced the number of cardiac arrests and poor outcomes in a surgical inpatient cohort.