Transcript (OR) Morning Briefing (ICU and Floor)

Morning Briefings and Huddles
Elizabeth Martinez, MD, MHS
Michael Rosen, PhD
© The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
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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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.
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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:
1. Maps out the plan of care
2. Identifies roles and responsibilities for each team
member
3. Heightens awareness of the situation
4. Allows the team to plan for the unexpected
5. Allows team members’ needs and expectations to
be met
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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
I
II
III
• What happened today, (last evening, overnight if applicable) that I need to
know about?
• Anesthesiology and OR Coordinators should meet with the Nursing Coordinator
to plan the day and review the schedule together.
• Review the day schedule for any changes, cancellations, or add-on cases.
• Are there any concerns after reviewing the OR schedule?
• Do you anticipate any potential defects or risks during the day? If so, how can
you reduce these risks? (May be completed at the beginning or end of the day.)
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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)
Unit:___________________________________
Date
Date
Safety Issue
New and Ongoing
Contact
Status
Goal
Safety Issue
Completed
Contact
Status
Goal
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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 onesided.
– 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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