Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition and Severity Assessment.

OBJECTIVE: To analyze relationships between provider-documented signs prompting sepsis evaluations, assessments of illness severity, and late-onset infection (LOI). STUDY DESIGN: Retrospective cohort study of all infants receiving a sepsis huddle in conjunction with a LOI evaluation. Participants were ≥3 days old and admitted to a level IV neonatal intensive care unit (NICU) from September 2018 through May 2021. Data were extracted from standardized sepsis huddle notes in the electronic health record, including clinical signs prompting LOI evaluations, illness severity assessments (from least to most severe: green, yellow, and red), and management plans. To analyze relationships of sepsis huddle characteristics with the detection of culture-confirmed LOI (bacteremia, urinary tract infection, or meningitis), we utilized diagnostic test statistics, area under the receiver-operator characteristic analyses, and multivariable logistic regression. RESULTS: We identified 1209 eligible sepsis huddles among 604 infants. There were 111 culture-confirmed LOI episodes (9% of all huddles). Twelve clinical signs of infection poorly distinguished infants with and without LOI, with sensitivity for each ranging from 2% to 36% and area under the receiver-operator characteristic ranging 0.49-0.53. Multivariable logistic regression identified increasing odds of infection with higher perceived illness severity at the time of sepsis huddle, adjusted for gestational age and receipt of intensive care supports. CONCLUSIONS: Clinical signs prompting sepsis huddles were nonspecific and not predictive of concurrent LOI. Higher perceived illness severity was associated with presence of infection, despite some misclassification based on objective criteria. In level IV NICUs, antimicrobial stewardship through development of criteria for antibiotic noninitiation may be challenging, as presenting signs of LOI are similar among infants with and without confirmed infection.

Improving clinician agreement and comfort through the development of a pediatric behavioral health huddle tool.

BACKGROUND: Hospitalized pediatric patients with behavioral health (BH) diagnoses awaiting transfer can exhibit behaviors that may lead to workplace violence such as aggression. Workplace violence can lead to discomfort in caring for these patients. Huddles can be used as a tool to identify potential for violence, to help address workplace violence, and improve clinician situational awareness. METHODS: Utilizing QI methodology, a BH specific huddle tool was created and implemented on an Acute Care floor that identified key components such as triggers and behavioral stability. Mixed methods were used to study the intervention including focus groups, surveys and measurement of agreement (surrogate for situational awareness). The aims of this quality improvement (QI) project were to 1) improve situational awareness by increasing agreement between team members 2) improve the overall comfort of the clinical team caring for BH patients by 10%. RESULTS: Agreement between clinicians on patient stability increased by 20%. Comfort in caring for BH patients increased by 4%. Providers reported the tool increased their understanding (89%) and communication (81%) regarding plan of care. APPLICATION TO PRACTICE: Standardized huddle tool can be utilized to increase situational awareness among team members caring for patients with behavioral health diagnoses and may help to address workplace violence.

Impact of a multidisciplinary sepsis huddle in the emergency department.

BACKGROUND: Sepsis is a leading cause of death in hospitals requiring prompt recognition and treatment. The sepsis bundle is the cornerstone of sepsis treatment. Studies have evaluated the impact of a sepsis huddle on sepsis bundle compliance but not in sepsis identification. OBJECTIVE: Measure the effect of a multidisciplinary sepsis bedside huddle in the Emergency Department (ED) on sepsis identification and sepsis bundle compliance. METHODS: Retrospective, single-center, cohort study. Pre-huddle patients were identified via Best Practice Advisory (BPA) alert on the electronic medical record from 11/01/2019-3/31/2020. The post-huddle group were patients for whom a sepsis huddle was activated from 11/01/2020-3/31/2021. RESULTS: 116 patients met inclusion criteria and 15 were determined to not have sepsis for a total of 21 pre-huddle and 80 post-huddle patients. Comparing pre-post results, sepsis huddle increased code sepsis activation (10% vs 91%, p < 0.001); sepsis bundle compliance (24% vs 80%, p < 0.001); antibiotics within one hour (33% vs 90%, p < 0.001); culture within one hour (67% vs 95%, p < 0.001), order entry <30 min. (29% vs 86%, p < 0.001); and median order entry time (48 vs. 3 min, p < 0.001). Post-huddle, 80% of order entries were ≤ 20 min. Logistic regression predicting sepsis code found huddle to be the first predictor, (p < 0.0000005). Hour-1 bundle compliance was predicted by physician/physician assistant order ≤30 min (R2 = 0.36, p < 0.0000005). CONCLUSION: Sepsis bedside huddle in the ED improves identification and sepsis bundle compliance. Results suggest increased order entry speed caused bundle improvement.

Safety huddles in paediatric intensive care unit: Implementation and staff perception in a resource limited setting.

Objective: To evaluate the perception, knowledge, empowerment and comfort level of critical care staff in relation to the implementation of safety huddles in paediatric intensive care unit of a tertiary care hospital. METHODS: The descriptive cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September 2020 to February 2021, and comprised physicians, nurses and paramedics who were part of the safety huddle. Staff perception regarding this activity was evaluated using open-ended questions that were scored on a Likert scale. Data was analysed using STATA 15. RESULTS: Of the 50 participants, 27(54%) were females and 23(46%) were males. Overall, 26(52%) subjects were aged 20-30 years age, while 24(48%) were aged 31-50 years. Of the total, 37(74%) subjects strongly agreed that safety huddle had been routinely held in the unit since initiation; 42(84%) felt comfortable sharing their concerns about patient safety; and 37(74%) considered the huddles worthwhile. Majority 42(84%) felt more empowered through huddle participation. Moreover, 45(90%) participants strongly agreed that daily huddle helped them in becoming clearer about their responsibilities. For safety risk assessment, 41(82%) participants acknowledged that safety risks had been assessed and modified in routine huddles. Conclusion: Safety huddle was found to be a powerful tool to create a safe environment in a paediatric intensive care unit where all team members can speak up freely about patient safety.

Daily huddle best practice: An Evidence-Based guide.

BACKGROUND: Daily huddles positively influence staff satisfaction and perception; standardization of a daily huddle should be prioritized to benefit from its effects. AIM: The aim of this project initiative was to implement an evidence-based, standardized daily huddle on an inpatient medical-surgical oncology unit. IMPLEMENTATION PLAN: A searchable question was developed, and the identified literature was critically appraised and synthesized for evidence-based recommendations. The recommendations for the structure and content of a daily huddle were implemented using a standardized format. OUTCOMES: Pre-implementation and post-implementation staff perception and satisfaction surveys yielded positive results. Improvements in effective communication and staff satisfaction were identified. IMPLICATIONS FOR PRACTICE: An effective daily huddle is essential for communicating pertinent information that can affect workflows and patient safety, as well as promoting teamwork and staff satisfaction.

COVID-19 identification in chest X-ray images using intelligent multi-level classification scenario.

COVID-19 is an evolving respiratory transmittable disease, and it holds all daily activity worldwide as a global pandemic. It appeared in the city of Wuhan (China) in November 2019 and slowly started spreading to the rest of the world. The number of cases keeps increasing drastically, leading to a shortage of medical resources and testing kids worldwide. As the physicians facing this problem, several scientists and specialists in Artificial Intelligent (AI) are rendering their support to healthcare professionals in the early detection of COVID-19 using chest X-ray image samples to determine the level of severity at a low cost. This paper proposed Genetic Deep Learning Convolutional Neural Network (GDCNN) architecture that includes Huddle Particle Swarm Optimization as an alternative to Gradient descent. Huddle PSO performs better when clubbed with GDCNN architecture. Based on publicly available datasets, trained chest X-ray images are used to predict and identify various pneumonia diseases. The proposed model performed better with an accuracy of 97.23%, a sensitivity of 98.62%, specificity of 97.0%, and precision of 93.0%. The proposed model act as a tool for earlier detection of COVID-19. In the future, we plan to apply the proposed model for the larger dataset and to predict various lung diseases.

Optimizing Huddle Engagement Through Leadership and Problem Solving Within Primary Care: Results from a Cluster-Randomized Trial.

BACKGROUND: Leaders play a crucial role in implementing and sustaining changes in clinical practice, yet there is limited evidence on the strategies to engage them in team problem solving and communication. OBJECTIVE: Examine the impact of an intervention focused on facilitating leadership during daily huddles on optimizing team-based care and improving outcomes. DESIGN: Cluster-randomized trial using intention-to-treat analysis to measure the effects of the intervention (n = 13 teams) compared with routine practice (n = 16 teams). PARTICIPANTS: Twenty-nine primary care clinics affiliated with a large integrated health system in the upper Midwest; representing differing practice types and geographic settings. INTERVENTION: Full-day leadership training retreat for team leaders to facilitate of care team huddles. Biweekly coaching calls and two site visits with an assigned coach. MAIN MEASURES: Primary outcomes of team development and function were collected, pre- and post-intervention using surveys. Patient satisfaction and quality outcomes were compared pre- and post-intervention as secondary outcomes. Leadership engagement and adherence to the intervention were also assessed. KEY RESULTS: A total of 279 pre-intervention and 272 post-intervention surveys were completed. We found no impact on team development (- 0.98, 95% CI (- 3.18, 1.22)), improved team credibility (0.18, 95% CI (0.00, 0.35)), but worse psychological safety (- 0.19, 95% CI (- 0.38, 0.00)). No differences were observed in patient satisfaction; however, results were mixed among quality outcomes. Post hoc analysis within the intervention group showed higher adherence to the intervention was associated with improvement in team coordination (0.47, 95% CI (0.18, 0.76)), credibility (0.28, 95% CI (0.02, 0.53)), team learning (0.42, 95% CI (0.10, 0.74)), and knowledge creation (0.74, 95% CI (0.35, 1.13)) compared to teams that were less engaged. CONCLUSIONS: Results of this evaluation showed that leadership training and facilitation were not associated with better team functioning. Additional components to the intervention tested may be necessary to enhance team functioning. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT03062670. Registration Date: February 23, 2017. URL: https://clinicaltrials.gov/ct2/show/NCT03062670.

The design of "TeamBirth": A care process to improve communication and teamwork during labor.

BACKGROUND: Despite evidence that communication and teamwork are critical to patient safety, few care processes have been intentionally designed for this purpose in labor and delivery. The purpose of this project was to design an intrapartum care process that aims to improve communication and teamwork between clinicians and patients. METHODS: We followed the "Double-Diamond" design method with four sequential steps: Discover, Define, Develop, and Deliver. In Discover, we searched professional guidelines and peer-reviewed literature to delineate the challenges to quality of intrapartum care and to uncover options for solutions. In Define, we convened an interdisciplinary group of experts to focus the problem scope and prioritize solution features. In Develop, we created initial prototype solutions. In Deliver, we engaged clinicians and patients in rapid cycle testing to iteratively produce a care process called "TeamBirth" that aims to improve team communication. RESULTS: We designed TeamBirth, an intrapartum care process composed of brief team meetings ("huddles") between clinicians and patients. Huddles are navigated by a shared planning board placed in the labor and delivery room in view of the patient and their care team. The board promotes transparent and reliable communication and contains four areas to be acknowledged or discussed: (a) the names of the team members, starting with the patient; (b) the patient's preferences; (c) the care plan for the patient, baby, and labor progress; and (d) when the next team huddle is anticipated. DISCUSSION: We identified an opportunity to improve the safety and dignity of childbirth care through an intrapartum care process that promotes reliable and structured communication and teamwork. Future work should evaluate the acceptability and feasibility of implementation and potential impact on safety and experience of care.

Performance Test of the Rotational Sensor blueSeis-3A in a Huddle Test in Fürstenfeldbruck.

Rotational motions play a key role in measuring seismic wavefield properties. Using newly developed portable rotational instruments, it is now possible to directly measure rotational motions in a broad frequency range. Here, we investigated the instrumental self-noise and data quality in a huddle test in Fürstenfeldbruck, Germany, in August 2019. We compare the data from six rotational and three translational sensors. We studied the recorded signals using correlation, coherence analysis, and probabilistic power spectral densities. We sorted the coherent noise into five groups with respect to the similarities in frequency content and shape of the signals. These coherent noises were most likely caused by electrical devices, the dehumidifier system in the building, humans, and natural sources such as wind. We calculated self-noise levels through probabilistic power spectral densities and by applying the Sleeman method, a three-sensor method. Our results from both methods indicate that self-noise levels are stable between 0.5 and 40 Hz. Furthermore, we recorded the 29 August 2019 ML 3.4 Dettingen earthquake. The calculated source directions are found to be realistic for all sensors in comparison to the real back azimuth. We conclude that the five tested blueSeis-3A rotational sensors, when compared with respect to coherent noise, self-noise, and source direction, provide reliable and consistent results. Hence, field experiments with single rotational sensors can be undertaken.

Using the 'huddle' to enhance interprofessional teamwork among nursing students through a podcast: a qualitative and exploratory pilot study.

BACKGROUND: Interprofessional teamwork is crucial for fostering healthcare performance and for minimizing adverse events. The daily huddle is an important arena for interprofessional interaction and communication between nurses and physicians in hospitals. Although prevalence strongly rooted in clinical practice, the huddle does not seem to be a prioritized area in nursing education programs. Taking part in a huddle is traditionally something nursing students learn in their clinical studies. Therefore, there is need for learning tools that can provide nursing students with quality assured training that can improve their preparation for interprofessional teamwork and strengthen the link between the educational institution and the field of practice. In this study, we have developed and tested a podcast to increase nursing students' competence in interprofessional teamwork when participating in huddles. The aim of the pilot study was to explore nursing students' experiences with utilizing a huddle-focused podcast as a learning tool during their clinical practice studies in the hospital. METHOD: This qualitative and exploratory pilot study used focus group interviews. Eleven third-year nursing students who had listened to the podcast during their practical studies at a medical hospital ward were included. The interviews were subjected to content analysis. RESULT: The analysis identified four categories that resonated across all participants in the focus group interviews: 1. understanding one's own role in the huddle; 2. being encouraged to speak up; 3. using the huddle as a flexible learning tool; and 4. being authentic but not always realistic. CONCLUSION: Findings indicate that the huddle-focused podcast seems to be valuable for nursing students learning about interprofessional teamwork. The podcast seemed especially useful in helping the students to understand their own role and to speak up in the huddle meetings. The positive experiences with the flexibility of the podcast learning tool are promising for use in other educational settings.

Emergency department sepsis huddles: Achieving excellence for sepsis benchmarks in New York State.

The sepsis order set at our institution was created with the intent to facilitate the prompt initiation of appropriate sepsis care. Once clinical features meeting criteria for systemic inflammatory response syndrome (SIRS) are identified and an infectious source is considered, a "sepsis huddle" is concomitantly initiated. The sepsis huddle was implemented in March of 2016 in order to increase compliance with the sepsis bundles. The sepsis huddle is called via overhead paging system in the emergency department (ED) to notify all staff that there is a patient present who meets SIRS criteria with concern for sepsis requiring immediate attention. The sepsis order set is utilized for these patients and includes laboratory testing, treatment, and monitoring items to meet sepsis "bundle" compliance. In addition, it suggests antibiotic options to be administered based on the presumed source of infection. Each team member responding to a sepsis huddle has a pre-established role outlined to facilitate timely treatment. The Centers for Medicare & Medicaid Services, (CMS), is part of the Department of Health and Human Services (HHS). CMS sepsis guidelines call for periodic patient reassessment, including repeat vital signs, pertinent physical examination findings, and timed lactic acid measurement to determine a patient's response to resuscitation efforts. Our established order set has automated some of these reassessment features to facilitate compliance. Sepsis huddle initiation also triggers a department staff member to track the timing and completion of serial blood draws. Utilizing and adhering to the guidelines of this methodology in the management of these patients has enabled our hospital to improve benchmarking compliance from previously underperforming at the 31st and 49th percentiles in 2015, prior to initiation of the huddle, to a peak compliance at the 81st and 91st percentiles in 2016 and 65th and 83rd percentiles in 2017 for the 3-hour and 6-hour bundles respectively.

Implementation of Situational Awareness in the Pediatric Oncology Setting. Does a 'huddle' Work and Is it Sustainable?

BACKGROUND: Huddles are short, regular debriefings that are designed to engage clinical staff in discussions about existing or emerging safety issues. They allow a brief conversation to take place creating a 'situational awareness' about the complexities of the healthcare environment for that day. METHODS: The huddle was implemented in a pediatric oncology service as an intervention aimed at improving patient safety and staff communication to enhance situational awareness. To ensure an efficient format for each huddle a huddle observational tool (HOT) was developed. An initial electronic anonymous survey focusing on safety and situational awareness was distributed to all of the multi-disciplinary (MDT) team. A second survey was disseminated 18 months post huddle introduction to scrutinize its effectiveness. Sustainability was assessed using staff attendance and huddle numbers. RESULTS: Four key areas demonstrated high situational awareness; safety awareness, incident management, communication and teamwork. Positive/negative pooled responses from both survey time points demonstrated a high percentage of positive responses, particularly relating to teamwork enhancement. The overwhelming finding was sustainability of the intervention of the huddle. The pediatric oncology services have now conducted over 700 huddles events over a three-year period. CONCLUSION: The initiation of the huddle has led to increased situational awareness and promotion of safety. It has been shown to be sustainable in the pediatric oncology setting, with durability and attendance of the huddle being the most significant outcome.

Safety huddle in a community nursing setting.

A safety huddle is a meeting held among district nurses, allied health professionals, specialist nurses, administrative staff, community matrons and healthcare assistants, also known as the wider multidisciplinary team. This article aims to identify and discuss the importance of safety huddles within a community nursing team. The author, a Specialist Community Practitioner District Nurse (SCPDN), explores why safety huddles were introduced and the implications of staff and patient safety if a safety huddle is not performed. The article also discusses the role of the SCPDN, how patient harm is sustained when communication failures occur within a team, new technologies implemented into practice and the implementation of safety huddles electronically.

Radiology Reading Room Huddles: Our Initial Experience.

OBJECTIVE. The objective of our study was to adapt the safety, methods, equipment, supplies, and associates, termed "S-MESA," communication tool from daily management huddles and implement it in radiology reading rooms to address the complexities of daily communications. We collected data on huddle logistics and perceived value from radiologists at an academic institution. MATERIALS AND METHODS. We constructed a 16-item survey composed of multiple-choice questions (single answer and multiple answers), statements requiring Likert scale ratings (from 1 [strongly disagree] to 5 [strongly agree]), and items requiring free text responses. The survey was distributed to 244 radiologists. Answers were collected over a 6-week period. RESULTS. The response rate was 41% (101/244). The majority of huddles were performed sometimes (59%) or daily or nearly daily (25%), and most lasted 5 minutes or less (83%), which was perceived as "just right" (87.5%). The components discussed more frequently in the huddle were availability (33.5%) and time goals (27%). Task review (19%) and miscellaneous (14%) were not as common. Huddles were valued for facilitating communication and better organizing the workday. CONCLUSION. Reading room huddles are feasible and perceived as useful. Moving forward, we are planning to integrate reading room huddles with multitier system huddles and include items that are of specific interest to radiology trainees.

Effects of cold weather on the sleeping behavior of Skywalker hoolock gibbons (Hoolock tianxing) in seasonal montane forest.

Considering the high energetic costs of maintaining constant body temperature, mammals must adjust their thermoregulatory behaviors in response to cold temperatures. Although primate daytime thermoregulation is relatively well studied, there is limited research in relation to nighttime strategies. To investigate how Skywalker hoolock gibbons (Hoolock tianxing) cope with the low temperatures found in montane forests, we collected sleep-related behavior data from one group (NA) and a single female (NB) at Nankang (characterized by extensive tsaoko plantations) between July 2010 and September 2011, and one group (BB) at Banchang (relatively well-managed reserve forest) between May 2013 and May 2015 in Mt. Gaoligong, Yunnan, China. The annual mean temperature was 13.3°C at Nankang (October 2010 to September 2011) and 13.0°C at Banchang (June 2013 to May 2015) with temperatures dropping below -2.0°C at both sites, making them the coldest known gibbon habitats. The lowest temperatures at both sites remained below 5.0°C from November to March, which we, therefore, defined as the "cold season". The hoolock gibbons remained in their sleeping trees for longer periods during the cold season compared to the warm season. Sleeping trees found at lower elevations and closer to potential feeding trees were favored during cold seasons at both sites. In addition, the gibbons were more likely to huddle together during cold seasons. Our results suggest that cold temperatures have a significant effect on the sleeping behavior of the Skywalker hoolock gibbon, highlighting the adaptability of this threatened species in response to cold climates.

Do safety briefings improve patient safety in the acute hospital setting? A systematic review.

AIMS: To synthesize current knowledge about the impact of safety briefings as an intervention to improve patient safety. BACKGROUND: Improving safety in health care remains an ongoing challenge. There is a lack of evidence underpinning safety enhancing interventions. DESIGN: Mixed method multi-level synthesis. DATA SOURCES: Four health literature databases were searched (Cinahl, Medline, Scopus and Health Business Elite) from January 2002 - March 2017. REVIEW METHODS: Thomas and Harden approach to mixed method synthesis. RESULTS: Following quality appraisal, 12 studies were included. There was significant heterogeneity in study aims, measures, and outcomes. Findings showed that safety briefings achieved beneficial outcomes and can improve safety culture. Outcomes included improved risk identification, reduced falls, enhanced relationships, increased incident reporting, ability to voice concerns, and reduced length of stay. CONCLUSION: Healthcare leaders should embrace the potential of safety briefings by promoting their effective use whilst allowing for local adaptation.

Sustaining the commitment to patient safety huddles: insights from eight acute hospital ward teams.

BACKGROUND: A recent initiative in hospital settings is the patient safety huddle (PSH): a brief multidisciplinary meeting held to highlight patient safety issues and actions to mitigate identified risks. AIM: The authors studied eight ward teams that had sustained PSHs for over 2 years in order to identify key contributory factors. METHODS: Unannounced observations of the PSH on eight acute wards in one UK hospital were undertaken. Interviews and focus groups were also conducted. These were recorded and transcribed for framework analysis. FINDINGS: A range of factors contributes to the sustainability of the PSH including a high degree of belief and consensus in purpose, adaptability, determination, multidisciplinary team involvement, a non-judgemental space, committed leadership and consistent reward and celebration. CONCLUSION: The huddles studied have developed and been shaped over time through a process of trial and error, and persistence. Overall this study offers insights into the factors that contribute to this sustainability.

Implementing team huddles in small rural hospitals: How does the Kotter model of change apply?

AIMS: To examine how the process of change prescribed in Kotter's change model applies in implementing team huddles, and to assess the impact of the execution of early change phases on change success in later phases. BACKGROUND: Kotter's model can help to guide hospital leaders to implement change and potentially to improve success rates. However, the model is under studied, particularly in health care. METHODS: We followed eight hospitals implementing team huddles for 2 years, interviewing the change teams quarterly to inquire about implementation progress. We assessed how the hospitals performed in the three overarching phases of the Kotter model, and examined whether performance in the initial phase influenced subsequent performance. RESULTS: In half of the hospitals, change processes were congruent with Kotter's model, where performance in the initial phase influenced their success in subsequent phases. In other hospitals, change processes were incongruent with the model, and their success depended on implementation scope and the strategies employed. CONCLUSIONS: We found mixed support for the Kotter model. It better fits implementation that aims to spread to multiple hospital units. When the scope is limited, changes can be successful even when steps are skipped. IMPLICATIONS FOR NURSING MANAGEMENT: Kotter's model can be a useful guide for nurse managers implementing changes.

Balancing the Needs of Patients and Learners in Surgery.

In this commentary, we explore the need for academic physicians to balance the needs of their patients and of learners during surgery. We approach this discussion from the perspective of the duty of care to the patient and reflect on methods to respect this duty of care but still maximize the educational experience of the learner without jeopardizing the patient's health. We also identify pedagogical methods to facilitate this balance, both in routine situations and during unforeseen events.

Situation, Background, Assessment, and Recommendation-Guided Huddles Improve Communication and Teamwork in the Emergency Department.

PROBLEM: Thousands of people die annually in hospitals because of poor communication and teamwork between health care team members. Standardized tools and strategies help increase the amount and quality of communication. Two structured communication methods include implementing huddles and the use of the situation, background, assessment, and recommendation (SBAR) communication framework. METHODS: To improve communication among nurse practitioners and registered nurses within a pediatric emergency department, a performance-improvement project with the structured processes of a joint patient evaluation and huddle was implemented. Data were gathered from 32 nurses and 2 nurse practitioners using structured observation and pre- and post-implementation surveys. The following outcomes were measured: presence or absence of joint patient evaluation and SBAR-guided huddle, verbalization of treatment plan, communication, teamwork, and nurse satisfaction. RESULTS: Eighty-three percent of patient encounters included a joint evaluation. A huddle structured with SBAR was conducted 86% of the time. Registered nurses and nurse practitioners verbalized patients' treatment plans in 89% of cases and 97% of cases, respectively. Improved teamwork, communication, and nursing satisfaction scores were demonstrated among the nurse practitioners and registered nurses. IMPLICATIONS FOR PRACTICE: This project showed the feasibility of a simple and inexpensive joint nurse practitioner-registered nurse patient evaluation followed by a structured huddle, which improved communication, teamwork, and nurse satisfaction scores. This performance-improvement project has the potential to enhance efficiency by reducing redundancy, as well as to improve patient safety through the use of structured communication techniques.