Study: Tiered-huddled systems improve adverse event reporting

Implementing tiered huddle systems throughout a health care system can improve the reporting of patient safety events, according to a study. Summarized this week in the Agency for Healthcare Research and Quality Patient Safety Network Collection, the study authors found implementing a series of brief, focused conversations that occur every morning between front-line staff, managers, directors and executives at 238 clinics and four hospitals led to a significant and immediate increase in the number of patient safety events reported per month. In addition, the reported numbers of unsafe conditions, near misses, no-harm events that reached patients and temporary harm increased. Tiered huddle systems “can become a cornerstone for promoting patient safety event reporting and help health care organizations achieve their high reliability goals,” concluded the authors, writing in the Joint Commission Journal of Quality and Patient Safety.(AHRQ Patient Safety Network article, 10/12/22)