PICU Starting Lineup

Project Topic:

Redesigning the shift huddle to increase RN attendance and engagement

Hospital, City and State:

Nemours Children’s Hospital, Wilmington, Delaware

Unit:

Pediatric Intensive Care Unit

CSI Participants:

• Evan Gardner, BSN, RN, CCRN
• Michelle Greenspan, BSN, RN, CPN, CCRN
• Olivia Keenan, BSN, RN
• Ashley Wilhelm, BSN, RN, CCRN

Project Goals/Objectives:

1. Increase RN attendance at huddle 50%
2. Increase PICU RN satisfaction with huddle 20%
3. Increase Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score to 4.0
4. Increase HWEAT Meaningful Recognition score to 4.0
5. Decrease RN turnover by 1 nurse

Project Outcomes:

1. Increased RN huddle attendance to 100%
2. 91.2% of PICU RNs find the Starting Lineup to be somewhat (33.3%) or very beneficial (56.8%)
3. Increased HWEAT True Collaboration score to 4.0 from 3.56
4. Increased HWEAT Meaningful Recognition score to 4.0 from 3.85
5. Increased HWEAT Aggregate score from 3.99 to 4.20 and increased all HWE standard scores
6. 91.2% of PICU RNs find the Starting Lineup to be somewhat (33.3%) or very beneficial (56.8%)
7. PICU RN turnover decreased by 2 nurses
8. These outcomes resulted in a positive estimated annual fiscal impact of $168,900

Project Overview:

The PICU’s morning huddle was difficult for bedside nurses to attend. The CSI team surveyed staff and found that often less than 60% of nurses were able to attend the daily huddle for various reasons. Nurses felt there was a lack of unit-based awareness, their work wasn’t valued or supported, and that valuable information was not being shared. The initial HWEAT survey revealed opportunities in the standards of True Collaboration (score of 3.65) and Meaningful Recognition (score of 3.85).

The CSI team redesigned the change of shift huddle to help increase the ability of RNs to attend. The initial goals of the morning huddle were to increase situational awareness and general safety awareness before the start of their shift while also providing an opportunity for in-the-moment meaningful recognition. We wanted the huddle to increase a sense of unity and teamwork among coworkers. We created a new huddle board and changed the time of occurrence to make attendance for RNs more attainable.

The overall feedback for our project has been positive. The Starting Lineup is now fully integrated into our unit routine. Post-clinical survey data revealed increased collaboration, situational awareness, and shared knowledge according to surveys completed by nursing staff. The follow-up HWEAT assessment revealed an increase in all six standards.