UW Health's mid-shift huddles produce better patient care, communication, and collaboration, nurse leader says.
Mid-shift huddling at University of Wisconsin Health has resulted in better care for high fall-risk patients, increased training in patient handling, and better teamwork, says a nurse leader there.
"The dedicated time for information-sharing and checking in with the entire team better equips the team with needed information to provide safe patient care and allows the team to support each other," says Sara Schoen, MSN, RN, CCRN, a nurse manager at UW Health in Madison, Wisconsin.
- Staff responsiveness was up nearly 6 points in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) report
- Safety scores improved by 13%
- Hand hygiene compliance increased and remained above 90%
- Patient falls declined significantly, with one unit achieving zero patient falls over five months.
When UW Health implemented mid-shift huddles about four years ago, the initial goal was on patient safety, but that has expanded to include informational content, as well, Schoen says.
Schoen shared with HealthLeaders the structure and benefits of the mid-shift huddles, which occur three times per day—once per shift— at 10:30 a.m., at 5 p.m., and 3 a.m.
This transcript has been edited for clarity and brevity.
HealthLeaders: How are mid-shift huddles different than those held at the beginning of the shift?
Sara Schoen: On my unit, huddles at change of shift are a high-level overview of what staff need to know to successfully start their shift, such as unit status (census, open beds, admits/discharges), staffing, and safety concerns (code status, high fall-risk patients/recent falls, patients of concern).
We also develop a WINK—What I Need to Know—each day that is read during this huddle over all shift changes. These cover quick unit or organizational updates that don't need much discussion but are helpful to know prior to starting a shift, such as updates to the visitor policy, PPE changes, or workflow updates related to COVID.
The care team leader facilitates shift-change huddles, and they are held at the nurses' station on the unit so all staff from the off-going and oncoming shift can attend the huddle. The goal of the shift-change huddles, which are to last no more than five minutes, is to set the team up with the needed information to successfully start their shift.
With mid-shift huddles, we go into more detail regarding unit status, and we also include more detail on our high fall-risk patients, cover informational and educational content, and check in with each staff member to redistribute resources if anyone needs help. The care team leader leads these huddles as well, and they are attended by the staff working that shift. Mid-shift huddles tend to last closer to 15 minutes and cover topics that need more in-depth discussion, such as a practice changes, lessons learned from recent healthcare-associated infections events on the unit, or educational content.
HL: What does the educational content consist of?
Schoen: Topics over the past couple weeks have included a refresher on use of nasogastric tubes, a brief overview of interventions for delirium from our geriatric [clinical nurse specialist] (CNS), lessons learned from a recent hospital-acquired pressure injury event on the unit, upcoming changes to the annual performance review process, and some diabetes updates from our diabetes resource nurse.
We have also used huddles to do some fun activities. In partnership with our psychiatric liaison CNS, we had our team complete eight weeks of content on different mindfulness/resiliency topics. We were able to review this content again for a few weeks last fall when our COVID census was increasing and feelings of stress on the unit were high.
Another fun activity we did was having each staff member determine their Myers-Briggs personality type; we then completed a week of different activities during mid-shift huddles using the various personality types to promote teambuilding.
HL: How have the mid-shift huddles benefited your nurses and your patients?
Schoen: A more recent addition to our mid-shift huddles is a discussion of the three patients at highest risk for falling, which are identified during huddle by the staff each shift. The RN and NA caring for each of these three patients are asked to share why the patient is at high risk for falling, any helpful interventions that all staff should know, how the patients mobilize, and what the mobility plan is for each patient for the day, as we really try to focus on mobility as an intervention for falls.
Knowing how each of these patients move is helpful to all staff when answering call lights or bed/chair alarms from these patients, and staff are better aware of which patients could use an extra set of eyes or additional assistance during the shift. Staff have been able to better assist each other with patient care after hearing this information, and all staff are better equipped to play a role in fall prevention on the unit.
We recently used mid-shift huddles to do 1:1 education with our staff on specific safe patient-handling devices with the goal of improving both staff and patient safety with transfers. This training showed an increase in staff use of this equipment, which benefitted both staff and patients. It would have been challenging to provide this education outside of scheduled shifts to the entire team, but using the dedicated time during mid-shift huddles allowed us to provide the education quickly and efficiently.
Ultimately, the dedicated time for information-sharing and checking in with the entire team better equips the team with needed information to provide safe patient care and allows the team to support each other through the huddle structure we have in place.
HL: What do your nurses think of the mid-shift huddles?
Schoen: Our team appreciates the dedicated time to check in with each staff member, as well as do a mid-shift check-in on the overall status of the unit. Staff also appreciate the time for conversation surrounding the topics covered during huddle rather than having to read the updates via email.
The biggest challenge we have is time—we have to be very conscious of the amount of content we cover during huddles to ensure staff can dedicate the time to attend huddle and not feel like they are being taken away from patient care.
HL: What would you say to other nurse leaders who might not see the benefit of mid-shift huddles?
Schoen: Changes on the unit come quickly, and it isn't efficient for the Care Team leader to communicate updates with each team member individually. Mid-shift huddles provide a venue for all staff to get an up-to-date status of the unit in real time.
In these fast-paced environments, it's very easy to lose sight of what's happening elsewhere on the unit when you're busy with your own work, and mid-shift huddles allow the team to collaborate to redistribute workload and real-time problem solve if needed. The collaborative structure of mid-shift huddles empower the entire team to be leaders in addressing safety concerns and promoting teamwork on the unit.
Communication of organizational updates, practice changes, or educational content through mid-shift huddles is a secondary gain for leaders. As leaders, we are continually challenged with finding new and creative ways of having real-time, efficient communication to ensure our teams are prepared with the needed information to provide safe and high-quality patient care each shift.
Mid-shift huddles provide a perfect venue for that communication, as they allow for real-time communication as well as provide a venue for discussion among the team. We can quickly disseminate information or education as issues or updates arise rather than relying on staff members to find time to read an email or attend a staff meeting weeks after the information was needed.
“In these fast-paced environments, it's very easy to lose sight of what's happening elsewhere on the unit when you're busy … and mid-shift huddles allow the team to collaborate to redistribute workload and real-time problem solve if needed.”
Sara Schoen, MSN, RN, CCRN, nurse manager
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
Data shows that mid-shift huddles create positive outcomes.
Mid-shift huddles identify real-time issues, like which patients are at highest risk for falls, so staff can better assist each other with caring for these patients.
Mid-shift huddles allow a team to collaborate to redistribute workload and real-time problem solve.