S.A.F.E 5: The huddle


Bringing the work of the previous sections together, we can now look to implement one of the core S.A.F.E interventions - the Huddle - which embodies open communication of the current situation on the ward, including identification of the sickest patients as well as those who staff and parents are concerned about. This really embeds situation awareness on the ward.

Introducing the huddle

The huddle is the core intervention. It aims to change the way you approach the care of children from reaction to anticipation. It is proactive and allows the sharing of information.

The underlying premise is that everyone around the child from parent, administrative and support staff, students, nurses doctors and allied professionals have a different lens or view on how the child is doing and everyone’s voice needs to be heard.

The huddle is structured and lasts a short time. Therefore, there are scripts appropriate for the clinical area. All need to be trained in the methodology to ensure it does not become a ward round.

What does implementing the huddle allow?

  • Proactive identification of risk ahead of deterioration
  • Unit-based Huddles on a regular basis, starting at the bedside with the nurse, doctor and patient
  • Three to four inpatient ward Huddles each day to provide collective understanding and shared insight
  • Unit or divisional Huddles as well as a hospital-wide Huddle
  • Continuous learning system to evaluate situation awareness at all levels

Types of huddle

Much of S.A.F.E has focused on the Ward Safety Huddle. However, in recent months, teams have expanded to include both the Ward Bedside Huddles and the Leaders Daily Safety Brief.

Huddle Suite: Identify - Mitigate - Escalate

Figure 1: The Huddle Intervention Suite


The S.A.F.E programme has developed scripts for the Ward Safety Huddle (see below for examples). You can modify these so they are more suitable for other Huddles.

Sets of questions that can be added are aimed at ascertaining the safety at any given time. The daily questions to be asked at different levels - ward, unit, division and hospital - are:

  • What did we do well? So that we can replicate this elsewhere.
  • Is there any past harm? Has patient care been safe in the past 4, 6, 12 and 24 hours?
  • How reliable are we? Are our clinical systems and processes reliable?
  • Are we sensitive to today's operations? Is the care we are delivering today safe?
  • Are we anticipating and preparing? Will the care we deliver be safe in the future?
  • Are we reviewing and learning from current and past operations? Are we responding and improving?


Situation Awareness Responsibilities - Individual; Team; Shared; Distributed

Figure 2: Responsibilities in situation awareness


This presentation provides an overview over situation awareness and where the huddle intervention came from. It also outlines some of the tools that can support the implementation of huddles, as well as encouraging innovation and further dveelopment.

Presentation 5: Using Huddles (PPT, 1.4MB)

Tools and worked examples

Huddles are a key intervention for introducing situation awareness, especially as part of a structured approach to communication in a given day. The tools and resources below will help you embed situation awareness as part of your local project.

Tool 1: Huddle scripts and trigger tools

To implement your huddles, there are two tools that you will find useful.

The first is the script. This outlines the process that will be followed during each huddle. This tends to be a list of questions used to prompt patients to be discussed. Here are three examples, but we encourage you to develop your own.

Great Ormond Street Hospital Safety Huddle Script (PDF, 91KB)

York Hospital Safety Huddle Script (MS Word, 29KB)

Royal Free Safety Huddle Poster (PDF, 506KB)

The second tool is the trigger tool. Essentially, this builds a second step into the huddle process, but allows someone, usually the Nurse in Charge, to go around the ward before the huddle and identify which patients will trigger a discussion at the huddle. This means that when at the huddle, only triggered patients are discussed. 

Birmingham Children's Hospital Huddle Trigger Tool (XLS, 13KB)

Tool 2: Drug-gle

This huddle is developed to discuss medications. The medical and nursing staff meet with the pharmacist regularly to review medication harm, risks and near misses, so that processes can be improved. 

The Drug-gle has been one of the major successes of S.A.F.E, with it spreading across multiple participating sites. Here are two examples.

Watford General Hospital Drug-gle Poster (PDF, 2.7MB)

Leeds Childrens' Hospital Drug-gle Poster (PDF, 143KB)

Tool 3: Huddle reflection tool

Developed by the S.A.F.E Evaluation Team, the Huddle Reflection Tool helps you assess the quality of a huddle.

Focusing in on four specific areas (structure, environment, collaborative culture and risk management), it is designed to give a point-in-time evaluation of the huddle and helps identify potential areas for improvement.

In early days, you might wish to use the tool frequently, perhaps daily as part of your PDSA cycles. However, as huddles become more embedded, the tool can be used less frequently, as a means of auditing the quality of your huddles.

S.A.F.E Huddle Reflection Tool (PDF, 67KB)

Tool 4: Parent and CYP Engagement

Parents are an important resource and a number of interventions have been developed for them. Examples of tools that have been developed by S.A.F.E sites include:

  • Daily goals: Identifying specific goals for each patient for a given day
  • Whiteboards: Providing whiteboards to help communication with patients, parents and families
  • Information Posters: To provide parents and families with information about S.A.F.E

Below are a number of examples of materials developed for patients, parents and families, to raise awareness of S.A.F.E and encourage their involvement.

Torbay Hospital "It's OK to Ask" Poster (PDF, 359KB)

Morecambe Bay Huddle Information Poster (PDF, 67KB)

Royal Free Parent and CYP Engagement Poster (PDF, 511KB)

University College Hospital Patient and Staff Engagement Poster (PDF, 356KB)


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