Contact Hours: 2
This educational activity is credited for 2 contact hours at completion of the activity.
Course Purpose
The purpose of this course is to equip healthcare professionals with the knowledge necessary to effectively implement and benefit from presurgical huddles.
Overview
Healthcare organizations continually strive to enhance the quality of surgical care they provide. Still, surgical errors continue to persist, posing significant risks to patient safety. It is estimated that surgical errors are the primary cause of approximately 75% of surgical malpractice. Many of these errors stem from preventable issues such as miscommunication, interruptions, distractions, fatigue, and deviations from standard practices during emergencies. While health administrators play a crucial role in overseeing the implementation of surgical huddles, ultimately, it is the responsibility of the frontline personnel to integrate them into their daily practices. This course seeks to equip healthcare professionals with the knowledge necessary to effectively implement and benefit from presurgical huddles.
Course Objectives
Upon completion of this course, the learner will be able to:
- Review the most common examples of surgical errors, and the most common types of high-risk surgeries.
- Review challenges in surgery, including rates of incidences of surgical errors.
- Understand consequences of surgical errors.
- Identify the steps of the presurgical huddle, and the benefits of the presurgical huddle.
- Understand compliance strategies to reduce missed presurgical huddles.
Policy Statement
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Disclosures
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
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Drain SpongeA type of medical tool used in wound care.Joint Commission on Accreditation of Health Care OrganizationA United States-based nonprofit tax-exempt 501 organization that accredits more than 22,000 US health care organizations and programs.Kocher ClampsHave teethed and serrated jaws that clamp the blood vessels tightly and do not let them slip.Medical ErrorAn act of omission or commission in planning or execution that contributes or could contribute to an unintended result. Miscommunication Failure to communicate clearly.Mortality RiskProvides a medical classification to estimate the likelihood of in-hospital death for a patient. Presurgical HuddleA commonly utilized process that promotes teamwork and prevents medical errors.Surgical ErrorAn unintentional, preventable injury occurring in the perioperative period that is not considered a known acceptable risk of surgery and could have been avoided by following appropriate procedure-specific training protocols.Surgical TimeoutThe surgical team’s short pause, just before incision, to confirm that they are about to perform the correct procedure on the correct body part of the correct patient.Swiss Cheese ModelIllustrates through layers in a block of Swiss cheese, the processes that can both prevent and cause safety concerns.World Health Organization (WHO) Surgical Safety ChecklistPublished in 2008 in order to increase the safety of patients undergoing surgery.
Healthcare organizations continually strive to enhance the quality of surgical care they provide. Still, surgical errors continue to persist, posing significant risks to patient safety.1 The consequences of surgical errors can be potentially catastrophic, heightening the risk of severe patient injury and death. It is estimated that surgical errors are the primary cause of approximately 75% of surgical malpractice cases – a financial burden estimated to cost healthcare institutions $5.96 billion annually.2 Many of these errors stem from preventable issues such as miscommunication, interruptions, distractions, fatigue, and deviations from standard practices during emergencies. To address these challenges and ensure the delivery of safe surgical care, a shift in thinking, planning, and management is essential. Healthcare facilities must adopt strategies, such as presurgical huddles, to meet the high-stake demands while maintaining high standards of care. While health administrators play a crucial role in overseeing the implementation of surgical huddles, ultimately, it is the responsibility of the frontline personnel to integrate them into their daily practices. This course seeks to equip healthcare professionals with the knowledge necessary to effectively implement and benefit from presurgical huddles. By understanding and integrating the principles and practices, healthcare teams can enhance communication, reduce errors, and improve patient outcomes.
Worldwide, approximately 313 million surgical operations are performed annually, with an estimated 4.2 million patients dying within 30 days of surgery.3 In the US, reports suggest at least 100,000 patients die following elective surgery.4,5 Still, surgical errors are likely under-reported, as such deaths are not documented on death certificates or reported mortality rates. It is important to note that surgical mortality risk is not the same for all procedures, and certain procedures are deemed riskier than others based on the likelihood of adverse events. There are eight types of surgeries identified “high risk” and include:6
- Lower extremity bypass graft (adverse risk: 11%)
- Abdominal aortic aneurysm repair (adverse risk: 8%)
- Colon resection (adverse risk: 5%)
- Coronary artery bypass graft or cardiac valve surgery (adverse risk: 4%)
- Transurethral resection of a bladder or prostate tumor (adverse risk: 3%)
- Cholecystectomy (adverse risk: 3%)
- Hysterectomy (adverse risk: 2%)
- Appendectomy (adverse risk: 1%)
Nearly half of all surgical adverse events for all procedures are attributed to technique-related complications, wound infections, and postoperative bleeding. It is estimated that up to 54% of these cases are preventable.6
Current Challenges in Surgery
Surgery is a dynamic specialty, where competency is a combination of good decision-making, technical skill, performance, and communication from multiple team members across a variety of disciplines.7 All these factors come together and affect a patient’s pathway from their initial preoperative appointment to the final postoperative appointment. With so many moving parts, there is no doubt that the operating theater is a high-risk environment with a range of mishaps that can occur. Surgical teams are aware of this, and therefore, frequently check and re-check documentation, review salient communications, re-appraise the operating theater, and re-evaluate the patient’s care. Still, surgical errors persist.
A surgical error is an unintentional, preventable injury occurring in the perioperative period that is not considered a known acceptable risk of surgery and could have been avoided by following appropriate procedure-specific training protocols.8 Examples of surgical errors include:
- Mislabeled surgical specimens
- Retained foreign bodies
- Wrong-patient errors
- Wrong procedure
- Wrong site
An analysis of these errors over the last few decades has revealed their cause is often multifactorial, resulting from a cascade of missteps from various elements that culminate into an adverse event. Miscommunication has been shown to be the leading cause. The Joint Commission on Accreditation of Health Care Organization reported that a total of 70% of errors involving severe injury or death could be related back to ineffective communication.9 Other common causes of surgical errors include:10
- Distractions
- Faulty equipment
- Insufficient training
- Lack of leadership
- Provider burnout
- Unnecessary or emergent procedures
- Violations of protocols
Unnecessary or emergent procedures, often performed under urgent and stressful conditions, can lead to rushed decisions and overlooked steps, increasing the risk of errors. Insufficient training can be the source of a lack of proficiency and confidence, making it more likely for mistakes to occur. Faulty equipment, whether due to design flaws, improper use, or maintenance deficiencies, can also lead to surgical errors. Distractions in the operating room, such as notifications, phone calls, conversations unrelated to the surgery, or even background noise, can impact a surgeon’s focus and precision. These interruptions can cause lapses in concentration, leading to errors that might otherwise have been avoided. Provider burnout, caused by excessive workloads, long hours, and high-stress environments, can lead to reduced attention and decision-making capacity, increasing the likelihood of mistakes. Lastly, violations of protocols, whether intentional or due to oversight, compromise the safety nets designed to prevent errors. For this reason, healthcare systems are typically characterized using the “Swiss Cheese” model, appearing robust on the outside but full of holes on closer inspection.6 Each “hole” represents a potential point of failure, such as the multiple reasons given above. When these “holes” align, errors can penetrate through multiple layers, leading to adverse events.
Errors can occur at multiple stages of the surgical process, including during preoperative planning, patient positioning, anesthesia administration, and intraoperative and postoperative care. Such errors can lead to surgical delays as well as severe complications such as bleeding, infection, tissue and organ damage, and death. The most common errors during surgery include:
- Retained foreign objects
- Wrong site errors
- Surgical burns
- Insufficient surgeon presence
- Surgical equipment unavailability/failure
- Falls in the operating room
Retained foreign object errors are incidents where surgical instruments, such as Kocher clamps, retractors, drain sponges, gauze pads, or towels, are inadvertently left inside the patient. Reports suggest these are seen in 66.2% of surgical error cases, 1 in every 18,000 surgeries and 1 in every 1000 abdominal surgeries.2 Reasons for this type of error include inadequate counting protocols, distractions in the operating room, communication breakdowns among the surgical team, and deviations from standard operating procedures. These errors increase the risk of infections and internal damage. They also require additional surgeries to retrieve the forgotten items.
Wrong-site surgical errors occur when a surgical procedure is performed on the wrong part of the body or the wrong patient. It also happens when the wrong procedure is performed. The incidence for wrong-site surgeries is approximately 1 in 100,000 surgeries and accounts for 15.5% of reported surgical error cases.2 These errors often result from miscommunication, lack of standardized protocols, and inadequate verification processes. Surgical burns represent 8% of surgical error cases.2 Surgical burns have been caused from oxygen ignition via electrocautery near the face, electrocautery burn to non-surgical areas, failure to use the manufacturer’s recommendation regarding alcohol-based antiseptic solution, and grounding pad burns.
Approximately 10% of surgical errors are reported to be the result of insufficient surgeon presence, equipment shortages or failure, or falls in the operating room.2 Insufficient surgeon presence refers to situations where the primary surgeon is not available for the entire duration of the surgery, or there is inadequate supervision of less experienced surgical team members. This can occur due to scheduling conflicts, the need for the surgeon to attend to multiple cases simultaneously, or unexpected emergencies that draw the surgeon away. When the primary surgeon is not consistently present, critical decisions may be delayed, and there may be a lack of continuity in the surgical plan, increasing the risk of additional errors.
Equipment shortages can occur because of inadequate inventory management, leading to the unavailability of essential surgical instruments and supplies when needed, delaying surgeries.2 Equipment failure, on the other hand, can result from improper maintenance, wear and tear, or design flaws such as malfunctioning electrocautery units, broken surgical instruments, or defective imaging equipment. These errors can lead to issues in the surgical process or even cause direct harm to the patient. Falls in the operating room can involve patients, surgical team members, or both. 2 For patients, falls may happen during the transfer to and from the operating table, or from inadequate restraint placement during the surgical procedure. For surgical team members, falls can result from slippery floors, cluttered walkways, or improper footwear. Falls can lead to significant injuries, disrupt the surgical procedure, and introduce additional complications.
Consequences of Surgical Errors
Surgical errors have many negative consequences for patients, their families, and healthcare providers.11 For the patient, surgical errors can cause lengthier hospital stays, increased healthcare costs, and an amplified risk of complications and mortality. In addition to the direct medical impact, surgical errors can take an emotional toll on patients and their families. The effect of surgical errors on healthcare providers is also profound.12 Healthcare providers often experience serious psychological distress, suffering from feelings of guilt, anxiety, and depression. The emotional burden can affect their confidence and job performance, potentially leading to burnout. The professional repercussions can include damage to their reputation, legal consequences, and disciplinary actions, which can further exacerbate their stress and anxiety. Moreover, surgical errors can erode trust between patients and healthcare providers, diminishing patient satisfaction and confidence in the healthcare system. Mistrust can lead to decreased compliance with medical advice and reluctance to seek necessary medical care in the future, further jeopardizing patient health. Hospitals and healthcare institutions also face substantial consequences. Surgical errors can result in legal liabilities, financial penalties, and increased scrutiny from regulatory bodies. They may harm the institution’s reputation, leading to a loss of patient trust and a potential decline in patient volume.
A presurgical huddle is a structured and collaborative meeting conducted by members of the surgical team to discuss surgical cases, identify possible problems, and set expectations before beginning. It serves as an opportunity for team members to gather and review pertinent patient information, discuss the surgical plans, address any concerns, and confirm everyone’s understanding of their roles and responsibilities. While there is no hard and fast rule as to when a presurgical huddle should be done, it is typically performed early in the morning, allowing for all the surgeries of the day to be discussed. Alternatively, it may also be done the evening before.
A presurgical huddle is not the same as a surgical timeout. While both these meetings involve team communication and coordination, they serve distinct purposes. The presurgical huddle occurs before the first patient enters the operating room. It focuses on preparing the surgical team, ensuring readiness for the day’s procedures. In contrast, a surgical timeout is a brief pause immediately before the surgical incision while the patient is on the table.14 During this time, the entire OR team verifies key patient information, the consent form, the procedure being performed, and the correct anatomical structures and sides involved, which should be marked on the patient’s skin. Teams may use standardized checklists, such as the World Health Organization (WHO) surgical safety checklist.15 If multiple procedures by separate surgical teams are planned, separate timeouts must be done.
The presurgical huddle is typically documented.13 Documentation may include a summary of the discussion points, decisions made, any identified risks or concerns, and confirmation of team members’ participation. Any changes or updates made to the surgical plan during the huddle are also documented. Accurate and thorough documentation of the presurgical huddle is essential for several reasons. It serves as a record of the team’s communication and decision-making processes, which can be invaluable for future reference or in the event of a patient safety incident. It also provides transparency and accountability, ensuring that every surgical team member is aware of their roles and responsibilities. Most importantly, documentation facilitates continuity of care by ensuring that all relevant information is accessible to subsequent members of the healthcare team.
Historical Context
The importance of presurgical huddles came to the forefront, with the broader recognition of medical errors being a significant challenge to public health. In 1999, the Institute of Medicine’s groundbreaking report, “To Err is Human,” highlighted the alarming prevalence of preventable surgical and non-surgical errors and their impact on patient safety. The report revealed that nearly 100,000 deaths occurred every year from medical errors, sparking widespread concern and calls for systematic improvements in healthcare delivery.16 The toll of medical errors continued to be a pressing issue in subsequent years, with a recent literature review uncovering an even higher incidence of up to 400,000 annual deaths from medical errors among hospitalized patients.17 Moreover, medical errors have a high cost, with some experts estimating adverse events costing the healthcare system $20 billion each year, and others approximating healthcare costs of $35 to $45 billion annually for hospital-acquired infections alone.18 The sobering data underscores the urgent need for healthcare systems to address the root causes of errors and enhance patient safety initiatives. Recognizing how communication breakdowns and teamwork failures contribute to medical errors, healthcare organizations began to implement initiatives such as presurgical huddles, which serve to enhance communication among surgical teams.
Challenges to Nationwide Implementation
While presurgical huddles have gained recognition, nationwide adoption and implementation vary based on factors such as institutional policies, surgical departments, resources, and norms within teams.19 Typically, in healthcare facilities with robust quality improvement programs, surgical huddles are more likely to be a part of their standard practice. These organizations often have the infrastructure to support such structured communication protocols and interdisciplinary team meetings. Facilities without these programs in place may face challenges in conducting presurgical huddles due to staffing issues, time constraints, and competing priorities. Cultural resistance is another hurdle preventing universal adoption. In specific surgical departments, particularly those with higher caseloads or fast-paced environments, there may be a greater emphasis on efficiency.20 This leaves little room for thorough huddles, which are assumed to slow down the workflow or add an unnecessary procedural step. While there may not be nationwide uniformity in the implementation of presurgical huddles, there is growing recognition of their value in enhancing patient safety and improving surgical outcomes. Professional organizations, accreditation bodies, and patient safety advocates continue to promote the adoption of presurgical huddles as a best practice in perioperative care.
Isolated studies have proven presurgical huddles to be an invaluable tool, offering numerous benefits that prevent errors and lead to better patient safety. Surgeons have reported that the day ran much more smoothly than usual. There were far fewer interruptions during the current cases to inquire about subsequent patient cases for that day.19 One of the primary reasons a presurgical huddle is so effective is that it enhances communication among the surgical team.21 During the huddle, multiple surgical team members gather to discuss every aspect of the day’s surgical plan. This open communication promotes a collaborative surgical environment where knowledge is shared, and concerns can be problem-solved. For instance, a surgical team prepares for a complex procedure and completes the presurgical huddle, where the lead surgeon outlines the steps of the surgery, the anesthesia provider discusses the anesthesia plan and potential complications, and the operating room nurse discusses the equipment and/or medications available. A nurse may also raise a concern about a recent allergy noted in the patient’s record. By examining these details openly, the team can devise a plan to manage the patient’s allergy, ensuring that everyone is prepared and coordinated.
Presurgical huddles play a crucial role in preventing surgical errors, such as wrong-site surgeries and equipment issues.19 By thoroughly reviewing the surgical plan and verifying patient details before starting the day, the team can identify and rectify any discrepancies before the surgery begins. Assume a patient is scheduled for a left knee arthroscopy. During the huddle, the team verifies the patient’s identity, the procedure, and the surgical site. The surgical technician confirms that all necessary equipment is available and functional, avoiding any delays or complications during the procedure. However, while going through the paperwork, a nurse noticed that the consent form lists the right knee as the surgical site. This discrepancy could have led to wrong site surgery and a myriad of legal complications post-surgery. Thanks to the presurgical huddle, this issue has been identified and promptly corrected, preventing a surgical error. Studies have also shown that with presurgical huddles, the number of total interruptions decreased considerably, and the number of questions per case outside the huddle was reduced by 77%.19 Presurgical huddles also contribute to more efficient surgical workflows because they minimize the need for additional information throughout the day, ensuring that all necessary preparations are completed before the surgery starts.22 Having a proactive approach helps streamline the process, enhancing overall operating room efficiency. For example, in a busy surgical department, the presurgical huddle identifies that a critical piece of equipment needed for a laparoscopic procedure is not yet sterilized. By addressing this issue before patients are brought into the operating room, the team can ensure equipment is sterilized in advance, ensuring the surgery proceeds on schedule.
The goal of presurgical huddles is to enhance patient safety and improve surgical outcomes. By maintaining a culture of safety and vigilance, surgical huddles help identify and mitigate potential risks, leading to fewer complications and better postoperative results. Consider a surgery for a patient with a known history of difficult airway management. During the presurgical huddle, the anesthesia provider on duty can highlight this issue and the need for specialized airway equipment, along with a more experienced anesthetist to be on standby. This proactive planning ensures that the team is prepared to deal with any airway complications, significantly diminishing the risk of adverse surgical events and improving the patient’s chances of a successful outcome.
Conducting a presurgical huddle involves a systematic series of critical steps designed to enhance communication, prevent errors, and ensure the safety of surgical procedures.19 The process begins with reviewing the list of patients scheduled for surgery. The first scheduled surgical case is selected, and the team verifies the patient’s identity using at least three identifiers, such as the patient’s name, date of birth, or medical record number. This step ensures that the patient’s information matches the details on the wristband, medical record, and surgical consent form. The next step is surgical site verification, which aims to prevent wrong-site surgeries. This involves marking the surgical site, with the patient’s involvement if applicable, and cross-checking the site against the consent form and medical records. The lead surgeon may state that the operation is on the left leg and ask the team to confirm the site marking and consent form, ensuring everyone agrees after verification. Following site verification, the team conducts equipment and supply checks to confirm the availability and functionality of all necessary equipment and supplies. This includes reviewing the inventory to ensure all required instruments and materials are present and sterile and testing all equipment to confirm it is working correctly.
The huddle then proceeds to a review of the surgical plans and potential complications.22 The lead surgeon should review the critical steps of the surgery and discusses the length of the procedure, any known risks, potential blood loss, patient-specific considerations, and post-op immobilization needs. They also outline contingency plans for possible complications. Each team member’s role during the procedure is also confirmed and discussed. For example, the anesthesia provider may review the anesthesia plan, including patient monitoring, and discuss preparations for potential complications. Lastly, the huddle addresses additional considerations, such as any last-minute concerns or questions.
Key Participants in a Presurgical Huddle
A typical surgical team consists of a variety of healthcare professionals from different disciplines, all bringing unique clinical expertise and experiences.9 They include lead surgeons, surgical residents (fellow), anesthesia providers, nurses, surgical technicians, pharmacists, and certain non-medical personnel. Among these professionals, nurses represent the largest group.24 The interdisciplinary team relies on each other’s skills and performs interdependent tasks in a highly dynamic work environment, all while sharing the mutual goal of delivering safe surgical care. Understanding the roles and contributions of each participant during the presurgical huddle is crucial for its success.
Lead surgeons responsible for the operations play a central role in the presurgical huddle.3 The effectiveness of huddles and the quality of information exchanged depends primarily on the surgeon. A responsible surgeon typically decides on the course of the procedure, makes strategy changes, and plans and performs the main surgical tasks. The surgeon also holds specialized information that is critical for the entire team, such as specific details about the surgical site, anticipated challenges, and steps of the procedure. Their input ensures that everyone is aligned with the plan and aware of any potential complications. Working under the supervision of the lead surgeon are surgical residents, who assist with parts of the procedure. They must be fully aware of all aspects of the surgical plan to ensure they are prepared and can contribute effectively.
Anesthesia providers are also essential participants in the huddle.3 They provide critical information about the patient’s medical history, current status, and the anesthesia plan. They discuss the type of anesthesia to be used, dosages, patient monitoring protocols, and any specific concerns related to the patient’s health. For instance, the anesthesia provider should review potential anesthesia-related risks, such as allergies or previous adverse reactions, ensuring the team is prepared to manage these issues effectively. Nursing staff, including circulating nurses and scrub nurses, are vital to the surgical procedure.23 Circulating nurses manage the overall environment of the operating room, ensuring that all necessary equipment and supplies are available and functioning. They also handle patient documentation and are responsible for patient advocacy throughout the surgery. Scrub nurses, on the other hand, assist the surgeon directly by managing sterile instruments and supplies during the procedure. Their detailed knowledge of the surgical procedure and equipment needs makes them indispensable for confirming that all necessary tools are ready and sterile, thereby preventing delays and potential contamination.
Surgical technicians oversee the preparation of the operating room, ensuring that all surgical instruments and equipment are sterilized and arranged according to the procedure’s requirements.25 During the huddle, surgical technicians confirm that all necessary tools and materials are available and in proper working order. They also provide support during the surgery by anticipating the surgeon’s needs and ensuring the efficient flow of instruments. Pharmacists bring expertise in medication management, confirming the medication plan, which may include verifying correct medication dosages.26 They also address any potential drug interactions or allergies, detect and correct errors associated with drug administration, and ensure that all necessary medications are available and prepared. Radiology technicians handle any imaging needs, ensuring that imaging equipment is available and functional, and that scans or images are ready for review during the procedure.27 Pathologists or pathology assistants provide immediate analysis of biopsy samples, influencing surgical decisions and ensuring timely communication of pathology results.28
Incorporating non-medical participants into the presurgical huddle depends on the specific needs and protocols of each healthcare facility, and their presence may or may not be mandatory.29 However, their contributions may help the surgical team feel well-supported in all logistical, technical, and patient-related matters. These participants may include the operating theater (OR) coordinators, patient representatives, and information technology (IT) staff. The operating room coordinator oversees the scheduling and logistical aspects of the surgery, and their presence in the presurgical huddle ensures the surgical team has all the necessary resources and support. Patient representatives may be required in cases where patient preferences, special needs, or family concerns need to be communicated to the surgical team. Information technology staff ensures that all electronic systems, such as patient records and surgical equipment software, are functioning correctly. They provide technical support to resolve any IT issues that could disrupt the surgical workflow.
Skipping presurgical huddles can have significant implications for patient safety and surgical outcomes.11 Without the opportunity to review critical information and address potential concerns, the surgical team may encounter challenges that could have been prevented or mitigated through proper huddle procedures. Potential risks and consequences of not performing a huddle include miscommunication among team members, inadequate preparation for the procedure, increased likelihood of errors or adverse events during surgery, and compromised patient safety.
Immediate actions must be taken if a presurgical huddle is not performed or is incomplete. Healthcare facilities should establish clear protocols for addressing missed huddles to minimize risks and ensure patient safety. These protocols may include the following steps:
- Immediate notification
- Reporting
- Documentation
- Emergency huddle
Immediate notification involves alerting the appropriate individuals, such as the charge nurse or surgical team leader, as soon as a huddle is missed or incomplete. Prompt communication ensures that a surgical issue is recognized and can be addressed in a timely manner. Reporting the incident according to facility policy is essential for accountability and transparency. By documenting the missed huddle, healthcare facilities can track occurrences, analyze trends, and implement corrective actions to prevent future occurrences. Documentation of the missed presurgical huddle should include details such as the reason for its omission and any actions taken to address the situation. This documentation serves as a record of events, facilitating communication among team members and providing valuable insights for quality improvement efforts. To rectify the problem, it may be beneficial to conduct an emergency huddle as soon as possible to quickly review essential information, confirm the surgical plan, and address any immediate concerns or risks. An impromptu huddle allows the surgical team to regroup, reassess the situation, and take appropriate actions to mitigate potential issues before proceeding with the procedure.
Compliance strategies must be implemented to ensure that presurgical huddles are consistently performed and integrated into standard practice. These include:
- Standardized protocols
- Leadership support
- Education and training
- Regular audits and feedback
Standardized protocols provide clear guidelines and procedures for conducting huddles, ensuring that all team members follow a standardized approach across different surgical procedures. Leadership support is essential for building a culture of safety and accountability within the healthcare facility. Strong leadership encourages active participation in huddle initiatives and emphasizes their importance in promoting patient-centered care. Education and regular training equip healthcare professionals with the knowledge and skills necessary to conduct presurgical huddles effectively. Comprehensive education on the purpose, process, and benefits of huddles ensures that all team members understand their roles and responsibilities, fostering engagement and buy-in. Regular audits and feedback mechanisms are essential for monitoring compliance with huddle protocols and identifying areas for improvement. They also allow healthcare facilities to identify best practices, address compliance issues, and continuously enhance the effectiveness of presurgical huddles.
Structured protocols, such as presurgical huddles, are essential tools, and surgical nurses play a central role in the successful implementation of presurgical huddles.30 Surgical nurses act as key communicators, facilitators, and advocates within the surgical team. Their responsibilities include driving the huddle forward, ensuring all aspects have been covered, including verifying patient information, ensuring all necessary equipment and supplies are available, and discussing potential complications with the team. Essentially, nurses act as leaders with the lead surgeon within the huddle and ensure all relevant matters are discussed and planned. To be able to manage this role and guide presurgical huddles to success, nurses must possess and continually develop a range of crucial skills such as effective communication skills, organizational skills, attention to detail, adaptability, and problem-solving skills.30 Nurses must communicate clearly and assertively to ensure that all team members understand the patient’s needs, surgical plan, and potential risks. This involves active listening, articulating concerns, asking clarifying questions, and providing concise updates. Effective communication also means being able to mediate and resolve any misunderstandings that may arise during the huddle.
Presurgical huddles require meticulous preparation and coordination. Nurses must be adept at organizing patient information, coordinating with various departments to ensure the availability of necessary resources, and scheduling the huddle at a time that accommodates all team members. Strong organizational skills also involve maintaining accurate records of the huddle, including documentation of discussions, decisions made, and any follow-up actions required. Attention to detail is paramount in the surgical environment, where even minor oversights can lead to significant adverse events. Nurses should be thorough in verifying patient identities, confirming surgical sites, checking equipment functionality, and reviewing the surgical plan for potential complications. During the huddle, nurses must pay close attention to the contributions of each team member, ensuring that no critical information is overlooked. This meticulous approach helps identify and address potential issues before they escalate, thereby reducing the risk of errors. The dynamic nature of the surgical environment means that nurses must be able to adapt quickly to changing circumstances. This includes responding to unexpected issues such as equipment failures, last-minute changes in the surgical plan, or emergent patient conditions. Effective problem-solving skills enable nurses to think on their feet, develop contingency plans, and take proactive steps to mitigate any disruptions to the surgical workflow.
Nurses are also the primary advocates for patients, bridging the patient and the surgical team.31 They should ensure the patient’s needs and concerns are addressed throughout the surgical process. In presurgical huddles, this advocacy role is critical. Nurses must ensure that all relevant patient information is communicated effectively to the team and that any potential risks are highlighted. Even post-huddle, many of the responsibilities fall on the surgical nurse.
Professional development helps surgical nurses remain proficient in conducting and participating in presurgical huddles. Regular workshops, simulations, and continuing education courses can help nurses stay updated on best practices and new developments in surgical safety. Training programs should emphasize the importance of presurgical huddles, the role of each team member, and strategies for developing vital skills such as effective communication and problem-solving during the huddle.
This growing awareness of the prevalence and impact of surgical errors has underscored the importance of enhancing patient safety across all healthcare settings, including the surgical environment. In response to these challenges, healthcare organizations have increasingly focused on implementing strategies to prevent errors, improve communication, and enhance teamwork among healthcare professionals. Presurgical huddles serve as a critical tool in achieving these goals. By bringing together the interdisciplinary surgical team to review and discuss the day’s surgical schedule, potential complications, and resource requirements, huddles ensure that everyone involved is on the same page. Structured communication helps to reduce the incidence of numerous preventable errors, significantly improving patient safety and surgical outcomes.
The benefits of presurgical huddles extend beyond error prevention. They lay the foundation of robust teamwork and collaboration, where each team member’s input is valued and considered. This inclusive approach enhances the overall efficiency of the surgical process and boosts morale and job satisfaction among healthcare professionals. By minimizing surgical delays and optimizing the use of operating room resources, presurgical huddles contribute to better time management and resource allocation within healthcare facilities. Nurses play a fundamental role in the success of presurgical huddles. Their responsibilities are crucial to the huddle’s effectiveness. However, to be successful, they must be armed with solid communication skills, organizational abilities, attention to detail, adaptability, and ongoing education.
Despite the clear advantages, the adoption and implementation of presurgical huddles face challenges, including resistance to change, staffing issues, and time constraints. As such, robust quality improvement programs, leadership support, and a commitment to continuous training are necessary. With these, it is equally important to have regular audits and feedback mechanisms in place to make certain presurgical huddles an integral part of surgical practice. As healthcare organizations continue to spotlight patient safety, presurgical huddles will be a vital component in the ongoing effort to deliver high-quality, error-free surgical care.
- Meara, J. G., Leather, A. J. M., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., Bickler, S. W., Conteh, L., Dare, A. J., Davies, J., Mérisier, E. D., El-Halabi, S., Farmer, P. E., Gawande, A., Gillies, R., Greenberg, S. L. M., Grimes, C. E., Gruen, R. L., Ismail, E. A., & Kamara, T. B. (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993), 569–624. https://doi.org/10.1016/s0140-6736(15)60160-x
- Cohen, A. J., Lui, H., Zheng, M., Cheema, B., Patino, G., Kohn, M. A., Enriquez, A., & Breyer, B. N. (2021). Rates of Serious Surgical Errors in California and Plans to Prevent Recurrence. JAMA Network Open, 4(5). https://doi.org/10.1001/jamanetworkopen.2021.7058
- Tschan, F., Keller, S., Semmer, N. K., Zimmermann, J., Huber, S. A., Wrann, S., Hübner, M., Banz, V., Prevost, G. A., Marschall, J., Candinas, D., Demartines, N., Weber, M., & Beldi, G. (2021). Effects of structured intraoperative briefings on patient outcomes: Multicentre before-and-after study. British Journal of Surgery, 109(1), 136-144. https://doi.org/10.1093/bjs/znab384
- Better care for surgical patients: Recognizing and responding to the unexpected to save lives. (n.d.). Ihpi.umich.edu. https://ihpi.umich.edu/news/ihpi-briefs/FTR
- Makary, M. A., & Daniel, M. (2016). Medical error—The Third Leading Cause of Death in the US. BMJ, 353(8056), i2139. https://doi.org/10.1136/bmj.i2139
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