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5-Step 'Huddle' Boosts Safety in Violent Patient Transfers

Analysis  |  By Christopher Cheney  
   February 01, 2019

Mayo Clinic develops handoff tool for potentially violent patients that features exchange of behavioral information between care teams.

For violent patients, an information-rich handoff from the emergency department to inpatient care can improve safety, recent research indicates.

Workplace violence is widespread in the healthcare sector. There are nearly 25,000 workplace assaults reported annually and 75% of the incidents occur at healthcare and social service facilities, according to the Occupational Safety and Health Administration. Compared to other vocations, healthcare workers are 20% more likely to be victims of workplace violence, the National Crime Victimization Survey found.

The recent research at Rochester, Minnesota-based Mayo Clinic examines implementation of a "huddle handoff communication tool" protocol for transfers of potentially violent patients.

"The huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the healthcare workplace," the researchers wrote.

Staff members felt safer after new handoff protocol was put in place. Nurses from the emergency department and the six inpatient units that participated in the study said they felt safe during patient transfers 100% of the time. ED staff satisfaction with the handoff protocol improved over time, from 53.3% to 75.0%.

A key element of the handoff protocol is the Potentially Aggressive/Violent Huddle Form, which features information about the patient that can be instructive for the receiving medical unit. "This tool is intended to ensure communication of behaviors and interventions that the patient had already received, which allowed inpatient teams to plan for how to respond on the receiving unit at the time the patient arrives," the researchers wrote.

Information on the huddle forms include whether the patient made aggressive statements, verbal threats, acts of physical aggression, and suicidal or homicidal ideation.

Calling violent patient huddles

The huddle handoff communication tool has five components:

  1. The nursing staff in the ED or receiving medical unit calls for a huddle handoff process
  2. The huddle form is completed
  3. The receiving medical unit gathers care team stakeholders and places a conference call to the ED care team for a tele-huddle to enable a thorough handoff effort
  4. The receiving medical unit prepares a room for the patient and puts a care management plan in place such as medications
  5. The receiving medical unit's staff meets with the patient at time of arrival

Christopher Cheney is the CMO editor at HealthLeaders.


Workplace violence is common in healthcare, with staff 20% more likely to experience workplace violence than employees in other sectors.

The handoff tool for transfers of potentially violent patients developed at Mayo Clinic focuses on preparing the receiving medical unit.

Nurses felt safer after implementation of the handoff tool, reporting they felt safe 100% of the time during patient transfers.

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