University of Michigan Medical School, Ann Arbor, Michigan, USA
Harvard Business School, Boston, Massachusetts, USA.
BMJ Qual Saf. 2020 Oct;29(10):1-2. doi: 10.1136/bmjqs-2019-009911. Epub 2020 Apr 7.
Despite significant advances, patient safety remains a critical public health concern. Daily huddles-discussions to identify and respond to safety risks-have been credited with enhancing safety culture in operationally complex industries including aviation and nuclear power. More recently, huddles have been endorsed as a mechanism to improve patient safety in healthcare. This review synthesises the literature related to the impact of hospital-based safety huddles.
We conducted a systematic review of peer-reviewed literature related to scheduled, multidisciplinary, hospital-based safety huddles through December 2019. We screened for studies (1) in which huddles were the primary intervention being assessed and (2) that measured the huddle programme's apparent impact using at least one quantitative metric.
We identified 1034 articles; 24 met our criteria for review, of which 19 reflected unit-based huddles and 5 reflected hospital-wide or multiunit huddles. Of the 24 included articles, uncontrolled pre-post comparison was the prevailing study design; we identified only two controlled studies. Among the 12 unit-based studies that provided complete measures of statistical significance for reported outcomes, 11 reported statistically significant improvement among some or all outcomes. The objectives of huddle programmes and the language used to describe them varied widely across the studies we reviewed.
While anecdotal accounts of successful huddle programmes abound and the evidence we reviewed appears favourable overall, high-quality peer-reviewed evidence regarding the effectiveness of hospital-based safety huddles, particularly at the hospital-wide level, is in its earliest stages. Additional rigorous research-especially focused on huddle programme design and implementation fidelity-would enhance the collective understanding of how huddles impact patient safety and other targeted outcomes. We propose a taxonomy and standardised reporting measures for future huddle-related studies to enhance comparability and evidence quality.
尽管取得了重大进展，但患者安全仍然是一个关键的公共卫生问题。日常交接班——旨在识别和应对安全风险的讨论——已被认为有助于增强航空和核电等运营复杂行业的安全文化。最近，交接班被认为是改善医疗保健中患者安全的一种机制。本综述综合了与基于医院的安全交接班相关的文献。
我们对截至 2019 年 12 月与基于医院的预定、多学科安全交接班相关的同行评审文献进行了系统综述。我们筛选了（1）交接班是主要干预措施的研究，以及（2）使用至少一个定量指标衡量交接班计划明显影响的研究。
我们确定了 1034 篇文章；其中 24 篇符合我们的审查标准，其中 19 篇反映了基于单元的交接班，5 篇反映了全院或多单元的交接班。在 24 篇纳入的文章中，无对照的前后对照研究设计最为流行；我们只确定了两项对照研究。在提供报告结果的完整统计显著性度量的 12 项基于单元的研究中，有 11 项报告了某些或所有结果的统计学显著改善。我们审查的研究中，交接班计划的目标和用于描述它们的语言差异很大。
虽然成功的交接班计划的传闻很多，我们审查的证据总体上看起来是有利的，但基于医院的安全交接班的有效性的高质量同行评审证据，特别是在全院层面，还处于早期阶段。额外的严格研究——特别是侧重于交接班计划设计和实施的一致性——将增强我们对交接班如何影响患者安全和其他目标结果的集体理解。我们提出了一个分类法和标准化报告措施，用于未来与交接班相关的研究，以提高可比性和证据质量。
