Situational Awareness Huddles in a Pediatric Cardiac Intensive Care Unit During the COVID-19 Pandemic

Kristen Christensen; Nora Colman; Kay Van Voorhis; Katherine Daniels; Haley Culpepper; Kiran Hebbar; Michael Wolf

doi:10.4037/ccn2021975

Situational Awareness Huddles in a Pediatric Cardiac Intensive Care Unit During the COVID-19 Pandemic

Crit Care Nurse. 2021 May 6:e1-e8. doi: 10.4037/ccn2021975. Online ahead of print.

Authors

Kristen Christensen¹, Nora Colman², Kay Van Voorhis³, Katherine Daniels⁴, Haley Culpepper⁵, Kiran Hebbar⁶, Michael Wolf⁷

Affiliations

¹ Kristen Christensen is a staff nurse and a clinical nurse leader in the cardiac intensive care unit, Children's Healthcare of Atlanta, Atlanta, Georgia.
² Nora Colman is an attending physician in the pediatric intensive care unit, Children's Healthcare of Atlanta, and an assistant professor of pediatrics, Emory University School of Medicine, Atlanta, Georgia.
³ Kay Van Voorhis is a staff nurse and an assistant nurse manager in the cardiac intensive care unit, Children's Healthcare of Atlanta.
⁴ Katherine Daniels is a staff nurse and an assistant nurse manager in the pediatric intensive care unit, Children's Healthcare of Atlanta.
⁵ Haley Culpepper is a staff nurse and nurse educator in the pediatric intensive care unit, Children's Healthcare of Atlanta.
⁶ Kiran Hebbar is an attending physician in the pediatric intensive care unit and Director of the Simulation Center, Children's Healthcare of Atlanta, and a professor of pediatrics, Emory University School of Medicine.
⁷ Michael Wolf is an attending physician in the cardiac and pediatric intensive care units and the Associate Medical Director of the cardiac intensive care unit, Children's Healthcare of Atlanta, and an associate professor of pediatrics, Emory University School of Medicine.

PMID: 33954707
DOI: 10.4037/ccn2021975

Abstract

Background: The COVID-19 pandemic has created challenges for provider teams working in intensive care units, including rapidly changing patient care regulations, staffing considerations, and preservation of personal protective equipment. The need for enhanced respiratory precautions for infected patients and patients under investigation has necessitated a new process for interventions and resuscitation.

Local problem: Along with changing regulations and equipment, significant staff anxiety surrounded caring for infected patients and preparing for emergency situations.

Methods: A huddle process was implemented in the pediatric cardiac intensive care unit for acutely ill patients who required enhanced respiratory precautions and were at risk of imminent decompensation, or who required a bedside procedure. During a huddle, the multidisciplinary team used process maps displayed in patient rooms; the huddle process created a situational awareness of events among these teams.

Intervention: After implementation of huddles, a survey was distributed to cardiac intensive care unit staff in order to understand their satisfaction with the huddle process.

Results: A total of 36 staff responded to the survey. They thought the huddles helped them to prepare for resuscitation scenarios, helped limit the number of personnel responding to an emergency, and reduced their anxiety surrounding caring for these patients. Staff suggested generalizing this huddle process to all patients at acute risk for decompensation in the cardiac intensive care unit.

Conclusions: A novel huddle process created situational awareness among staff caring for patients requiring enhanced respiratory isolation because of COVID-19. Multidisciplinary huddles allowed staff from various disciplines to apply a process map for interventions and resuscitations among critically ill children with heart disease.