Using Mid-Shift Huddles to Improve Care and Teamwork

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Start of Shift and End of Shift Huddles are pretty routine in most acute care settings. There is strong evidence that huddles improve communication, team collaboration, collective awareness, and safety. But the reality is that a lot can happen in 12 hours on busy units with admissions, transfers, and discharges. Today, many health systems are staffed with nurses with limited experience who can easily become overwhelmed during the course of their shifts. Without a check-in to see where everyone is with their work – team backup may not occur, and patient safety might be compromised.

In a reason article in Health Leaders Media, nurse leaders from the University of Wisconsin Health reported their experience and outcomes implementing the mid-shift huddle. In their setting, these mid-shift huddles happen at scheduled times every day (they chose 10:30 AM, 5:00 PM, and 3:00 AM). This standardization of the times makes sense if the mid-shift huddle becomes a routine part of nursing practice.

UW Health had impressive results with mid-shift huddles. It increased their HCAHPs scores, reduced falls, and improved staff satisfaction. One strategy was to talk in the mid-shift huddle about the three patients who were most at risk for falling. This allows staff even closer attention to call lights from these rooms. Frequent huddles have also been found to promote the additional advantages of sharing clinical details and census data and, just in time, education, staffing updates, announcements, and congratulations.

Some leaders may read this and think that it is a great idea, but we can’t do this with our staffing. If you are having staffing challenges, you probably need this more than you know. We know from research that teamwork grows from conversations that we have or don’t have with one another. In this turbulent time, it is best to err on the side of too many conversations and too much information rather than too little.

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