Background. Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted. Objective. The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians. Design. Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster. Setting. Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals. Participants. Physicians in participating programmes. Intervention. Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months. Main outcome and measures. The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety. Results. The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of ‘Organisational learning’ increased significantly from 35% (26%) to 54% (23%), p=0.00, ‘Response to error’ 37% (24%) to 52% (22%), p=0.025 and ‘Communication about error’ 36% (28%) to 64% (42%), p=0.016 after implementation. Conclusions and relevance. Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians.
- Une étude bien ficelée qui porte sur une intervention simple : l’organisation régulière de « huddles », brèves rencontres bien standardisées de médecins autour de faits en rapport avec la sécurité des patients. Elle est étudiée dans un schéma (étude randomisée en grappes avec permutation séquentielle) qui semble compliqué, mais qui répond aux critiques émises sur les études « avant-après ». L’objectif est la réduction des événements indésirables (EI), qui sont quantifiés par la revue de dossiers tirés au sort en suivant un protocole standardisé pour les quatre hôpitaux canadiens participants. L’effet du protocole sur la culture de sécurité est évalué par le questionnaire Hospital Survey On Patient Safety Culture (HSOPSC) bien connu. La fréquence des EI est inférieure de 12% après l’intervention (p=0,016), sans changer leur gravité ou leur nature (sauf les EI médicamenteux, qui diminuent sur l’un des quatre sites). Le score HSOPSC de mesure de la culture de sécurité augmente de 2,3 à 2,8 (p=0,010). L’intervention a été bien acceptée, malgré la survenue de la pandémie de Covid-19 pendant l’étude : les participants lui sont restés fidèles. Les huddles étaient parfois tenus en réaction à un événement, mais l’étaient plus souvent avant qu’une conséquence n’apparaisse. Alors que les analyses d’EI s’appesantissent surtout sur les erreurs médicamenteuses, les huddles insistent davantage sur les problèmes organisationnels (transfert d’information) et sur les erreurs de diagnostic ou d’interprétation de résultats. L’outil est bien accepté et digne d’intérêt.
Guo M, Bayley M, Ye XY, et al.
Impact of medical safety huddles on patient safety: A stepped-wedge cluster randomised study. BMJ Qual Saf. 2025:10.1136/bmjqs-2025-019170. Doi : 10.1136/bmjqs-2025-019170.