One of the many challenges the COVID-19 pandemic has posed is communication among clinicians on inpatient floors. As a recent commentary in the New England Journal of Medicine (NEJM) put it, they are “often working in newly formed teams with improvised and untested protocols in makeshift spaces to care for an overwhelming number of critically ill patients with a poorly understood disease.”

Identifying actual or potential stressors can help everyone support one another and establish plans for situations that may arise.

Colleen Snydeman, RN
Director, Patient Care Services, Office of Quality and Safety

Enter the Circle Up Huddle: a quick exchange of crucial information not only among physicians, nurses and other clinicians on the floor, but also unit coordinators and other support staff. “Circle Up Huddles focus on key operational, clinical and safety concerns and, importantly, carve out time to check in with staff on how they are doing and to identify stressors,” says Colleen Snydeman, RN, director of the Patient Care Services' Office of Quality and Safety.

Adds Karen Miguel, quality and safety staff specialist for Patient Care Services, “Lack of communication is the No. 1 reason things go wrong. A Circle Up Huddle is an expeditious way to get a group on the same page and help them do their jobs better.”

Circle Up Huddles—coined by leaders at Boston’s Center for Medical Simulation, Mass General and other area hospitals—are different from usual clinical gatherings, according to these leaders in their NEJM commentary. “Unlike patient handoffs, which are usually nurse-nurse or doctor-doctor conversations, Circle Up briefings and debriefings aim to include the entire team of clinicians and staff for the shift. Unlike rounds, these are 10- to 15-minute—or less—conversations that are not isolated to details regarding individual patients. Instead, these conversations develop a situational overview and plan for the shift.”

Yet there is an additional feature that has proven particularly vital during the pandemic: peer support.

“Identifying actual or potential stressors can help everyone support one another and establish plans for situations that may arise,” says Snydeman, who recently co-presented to Mass General staff about the Circle Up Huddles during the hospital’s National Patient Safety Awareness Week.

All 44 inpatient units across the hospital now use Circle Up Huddles. “A silver lining of the pandemic is that we hope these improvements will outlive it,” she says.