Letter to the Editor. Importance of multidisciplinary morning team huddles in the neurosurgical unit

Phillip C. Copley BSc, BMBS, MRCS(Ed) and Andreas K. Demetriades MBBChir, MPhil, FRCS(NeuroSurg)
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  • Western General Hospital, Edinburgh, United Kingdom
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TO THE EDITOR: We congratulate Chan and Vadera1 on their excellent report on the efficacy of short neurosurgery-led morning huddles in reducing laboratory and pharmacy costs per patient, reducing the number of ICU days, and improving patient satisfaction with the overall delivery of their neurosurgical service (Chan AY, Vadera S: Implementation of interdisciplinary neurosurgery morning huddle: cost-effectiveness and increased patient satisfaction. J Neurosurg 128:258–261, January 2018). The authors implemented a 30-minute multidisciplinary morning meeting on weekdays that was led by the neurosurgical team and involved pharmacists, physical/occupational therapists, ICU nurses, and case managers. Analysis of data from the 12 months prior to implementation of the huddle was compared to that of the subsequent 15 months. Of note, the average number of days spent in the ICU decreased by approximately half a day per patient (effect size 3.24, p < 0.001). Although both laboratory and pharmacy expenses per patient decreased, overall costs showed no change. Patient satisfaction surveys revealed that the multidisciplinary approach improved patients’ understanding of their disease and how to take prescribed medication. There was also a greater proportion of patients who stated that they would “strongly recommend” the hospital based on their experience.

We believe that the rewards of performing morning meetings such as the huddles described above are immense. At our institution we have held similar meetings for many years. First, we have a neuroradiology meeting in which we discuss new cases referred over the previous 24 hours and any pertinent scans required. We then have a preoperative morning huddle highlighting key issues surrounding the anesthetic, surgical, and postsurgical considerations for the day’s operating cases. We believe that this multidisciplinary input has multifaceted implications, including reduced medication errors, timely discharge from the ICU, more efficient bed management, greater patient satisfaction, and lower overall costs. Chen and Vadera have objectively quantified these benefits, although they rightly highlight the unexpected disparity between laboratory/pharmacy cost savings and overall savings, which clearly requires further research. Aside from these measureable effects, the multidisciplinary meetings are of great benefit in improving teamwork dynamics. Communication across specialties and between different clinicians has certainly evolved in our unit since the genesis of these meetings, and this likely improves clinicians’ overall job satisfaction. Cross-specialty consults, prioritization of investigations, and troubleshooting of issues brought up during meetings certainly facilitates more rapid joint decision-making. This is especially important in a post–reduction-of-hours era in which multiple handovers disrupt continuity of care and in which better teamwork with a more structured approach to decision-making is key.

Stapley et al. assessed the impact of huddles in the pediatric setting and demonstrated improved communication, teamwork, and efficiency.2 One challenge they highlighted was the potential for more junior staff to be excluded from the meetings because of other commitments, which contributes to reinforcement of the traditional hierarchical structure ingrained in medicine. Huddles that are able to incorporate the entire team are likely to be most effective, leading to the greatest outcomes for patients and maximizing staff satisfaction.

Disclosures

The authors report no conflict of interest.

References

  • 1

    Chan AY, Vadera S: Implementation of interdisciplinary neurosurgery morning huddle: cost-effectiveness and increased patient satisfaction. J Neurosurg 128:258261, 2018

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  • 2

    Stapley E, Sharples E, Lachman P, Lakhanpaul M, Wolpert M, Deighton J: Factors to consider in the introduction of huddles on clinical wards: perceptions of staff on the SAFE programme. Int J Qual Health Care 30:4449, 2017

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Response

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Contributor Notes

INCLUDE WHEN CITING Published online May 11, 2018; DOI: 10.3171/2018.1.JNS18102.

Disclosures The authors report no conflict of interest.

  • 1

    Chan AY, Vadera S: Implementation of interdisciplinary neurosurgery morning huddle: cost-effectiveness and increased patient satisfaction. J Neurosurg 128:258261, 2018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Stapley E, Sharples E, Lachman P, Lakhanpaul M, Wolpert M, Deighton J: Factors to consider in the introduction of huddles on clinical wards: perceptions of staff on the SAFE programme. Int J Qual Health Care 30:4449, 2017

    • Crossref
    • Search Google Scholar
    • Export Citation

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