{
  "abstract": "Background Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted.Objective The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians.Design Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster.Setting Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals.Participants Physicians in participating programmes.Intervention Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months.Main outcome and measures The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety.Results The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of ‘Organisational learning’ increased significantly from 35% (26%) to 54% (23%), p=0.00, ‘Response to error’ 37% (24%) to 52% (22%), p=0.025 and ‘Communication about error’ 36% (28%) to 64% (42%), p=0.016 after implementation.Conclusions and relevance Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians.Trial registration number NCT05365516.",
  "authors": [
    {
      "affiliations": [
        "University Health Network, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"
      ],
      "name": "Meiqi Guo"
    },
    {
      "affiliations": [
        "University Health Network, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"
      ],
      "name": "Mark Bayley"
    },
    {
      "affiliations": [
        "Department of Biostatistics, University Health Network, Toronto, Ontario, Canada"
      ],
      "name": "Xiang Y Ye"
    },
    {
      "affiliations": [
        "University Health Network, Toronto, Ontario, Canada",
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"
      ],
      "name": "Richard Dunbar-Yaffe"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada",
        "Hennick Bridgepoint Hospital, Sinai Health System, Toronto, Ontario, Canada"
      ],
      "name": "Chris Fortin"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada",
        "Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada"
      ],
      "name": "Katharyn Go"
    },
    {
      "affiliations": [
        "Cancer Quality Lab, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada",
        "Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada"
      ],
      "name": "Alyssa Macedo"
    },
    {
      "affiliations": [
        "University Health Network, Toronto, Ontario, Canada",
        "Currently Unaffiliated, Toronto, Ontario, Canada"
      ],
      "name": "John Matelski"
    },
    {
      "affiliations": [
        "Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada",
        "University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"
      ],
      "name": "Amanda Mayo"
    },
    {
      "affiliations": [
        "Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Family Medicine, Sinai Health System, Toronto, Ontario, Canada"
      ],
      "name": "Jordan Pelc"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada"
      ],
      "name": "Lawrence R Robinson"
    },
    {
      "affiliations": [
        "Centre for Quality Improvment and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Leahora Rotteau"
    },
    {
      "affiliations": [
        "University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada",
        "Surgery, Division of Orthopaedics, Sinai Health System, Toronto, Ontario, Canada"
      ],
      "name": "Jesse Wolfstadt"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Peter Cram"
    },
    {
      "affiliations": [
        "University of California San Francisco St Mary’s and Saint Francis Hospitals, San Francisco, California, USA"
      ],
      "name": "Lauren Linett"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada",
        "Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Sinai Health System, Toronto, Ontario, Canada"
      ],
      "name": "Christine Soong"
    }
  ],
  "title": "Impact of medical safety huddles on patient safety: a stepped-wedge cluster randomised study",
  "uid": "c72d7525-782d-5119-92e9-af2341606087"
}