Background ‘Situation Awareness For Everyone’ (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the ‘huddle’, a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle.
Methods A cross-sectional observational design was used to psychometrically develop the ‘Huddle Observation Tool’ (HOT) over three phases using standardised psychometric methodology. Huddles were observed across four NHS paediatric wards participating in SAFE by five researchers; two wards within specialist children hospitals and two within district general hospitals, with location, number of beds and length of stay considered to make the sample as heterogeneous as possible. Inter-rater reliability was calculated using the weighted kappa and intraclass correlation coefficient.
Results Inter-rater reliability was acceptable for the collaborative culture (weighted kappa=0.32, 95% CI 0.17 to 0.42), environment items (weighted kappa=0.78, 95% CI 0.52 to 1) and total score (intraclass correlation coefficient=0.87, 95% CI 0.68 to 0.95). It was lower for the structure and risk management items, suggesting that these were more variable in how observers rated them. However, agreement on the global score for huddles was acceptable.
Conclusion We developed an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle. Future research should examine whether observational evaluations of huddles are associated with other indicators of safety on clinical wards (eg, safety climate and incidents of patient harm), and whether scores on the HOT are associated with improved situation awareness and reductions in deterioration and adverse events in clinical settings, such as inpatient wards.
- healthcare quality improvement
- patient safety
- safety culture
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Contributors JEC led the research and drafting of the paper under the supervision of JD, and JEC and JD rated the huddles and provided oversight of the research. JH conducted the literature review and developed the initial observation tool. ESh, DG and ESt conducted the observations of the huddles. NS and PL provided expert input on revising the observation tool. All authors contributed to the drafting of the paper.
Funding Situation Awareness For Everyone (SAFE) is a Health Foundation funded programme; both the implementation of SAFE and the evaluation were funded by the Health Foundation. This work was also supported by funding from WellChild, the funding was specifically to support evaluation work around perspectives of parents and young people and to support patient and parent involvement in the research. This programme of work and evaluation was also supported by the Royal College of Paediatrics and Child Health (RCPCH) which leads on the delivery of the programme. Sevdalis’ research is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. Sevdalis is a member of King’s Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King’s College London. Its work is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’sCollege Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust), Guy’s and St Thomas’ Charity, the Maudsley Charity and the Health Foundation. Deighton was supported by the National Institute for Health Research (NIHR) Collaboration for Leaderships in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or RCPCH.
Competing interests None declared.
Ethics approval Dulwich Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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