Evidence Based Practice Unit, University College London and the Anna Freud Centre, London, UK.
Department of Psychology, University of Roehampton, London, UK.
BMJ Qual Saf. 2018 May;27(5):365-372. doi: 10.1136/bmjqs-2017-006513. Epub 2017 Sep 19.
'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.
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.
Interrater 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.
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.
“人人具备态势感知能力”（SAFE）是一个为期 3 年的项目，旨在提高临床团队的态势感知能力，以便发现住院病房中儿童潜在的恶化和其他潜在风险。其主要干预措施是“碰头会”，即一种结构化的病例管理讨论，是促进态势感知的核心。本研究旨在开发一种观察性评估工具，以评估碰头会期间发生的团队流程，包括碰头会的效果。
采用横断面观察性设计，使用标准化心理计量学方法分三个阶段对“碰头会观察工具”（HOT）进行心理计量学开发。由五名研究人员在参与 SAFE 的四家 NHS 儿科病房观察碰头会；两家在专科医院，两家在地区综合医院，考虑到地理位置、床位数量和住院时间，以使样本尽可能具有异质性。使用加权 kappa 和组内相关系数计算组内一致性。
协作文化的组内一致性可接受（加权 kappa=0.32，95%CI 0.17 至 0.42），环境项目（加权 kappa=0.78，95%CI 0.52 至 1）和总分（组内相关系数=0.87，95%CI 0.68 至 0.95）。结构和风险管理项目的一致性较低，这表明观察者在评估这些项目时差异较大。然而，碰头会的整体评分的一致性是可以接受的。
我们开发了一种观察性评估工具，以评估碰头会期间发生的团队流程，包括碰头会的效果。未来的研究应考察观察评估碰头会是否与临床病房的其他安全指标（如安全氛围和患者伤害事件）相关，以及 HOT 评分是否与临床环境（如住院病房）中的态势感知能力提高、恶化和不良事件减少相关。
