June 2021
The Surgical Safety Huddle: A Novel Quality Improvement Patient Safety Initiative
​Author Biographies


Carolyn Cullinane (carolyncullinane@rcsi.com) is a surgical specialist registrar in general surgery in Ireland. Having completed her medical degree with distinctions from the University of East Anglia in 2015, Carolyn moved to Northern Ireland to do her foundation years training. Carolyn was successfully appointed to core surgical training and higher surgical training in Ireland and is currently working in General, Breast and Endocrine Surgery in St. Vincent’s University Hospital in Dublin. Carolyn obtained a Master in Surgery from University College Cork in 2019 and was awarded a scholarship to do a Healthcare Leadership master's program with University College Cork in 2020. Carolyn has a specialist interest in quality improvement and patient
safety initiatives in surgery as evident from the patient safety huddle.Catharina Healy works as a clinical nurse manager for the Deteriorating Patient Support and Outreach Team at Cork University Hospital. She graduated with a Bachelor of Science degree in nursing in 2009 from Cork University Hospital. From there she gained experience in an acute medical unit in St. Mary’s Hospital London. Her passion grew for acute care and she moved to Dublin in 2012 to commence her intensive therapy career at Beaumont Hospital General Intensive Care
Unit. Healy completed a postgraduate diploma in intensive therapy from the Royal College of Surgeons in Ireland, finishing with first class honors in 2015. She completed a leadership and management certificate in 2016 from the National College of Ireland.

Mary Doyle is currently working as a clinical nurse manager for the Deteriorating Patient Service in Cork University Hospital in both a clinical and educational role. She has extensive specialist surgical and intensive care nursing experience in Ireland and Australia. Doyle is a registered general nurse and registered prescriber of ionizing radiation. She has completed a diploma and bachelor’s degree in nursing studies; diploma in Safety, Health, and Welfare at Work; postgraduate diploma in cardiac and intensive care nursing; master’s degree in nursing studies; and, most recently, a certificate in nurse prescribing in ionizing radiation, as well as a number of other courses. Helen McCarthy is a registered general and children’s nurse working in an acute medical/surgical setting. She holds a Bachelor of Science in children’s and general nursing and Master of Science in nursing research.

Claire Costigan is a registered advance nurse practitioner and lead nurse on the Deteriorating Patient Service in Cork University Hospital. She has worked in intensive care units (ICUs) in Ireland and Australia and she has a postgraduate diploma in cardiac and intensive care nursing (2012). After 10 years working in various ICUs, she became the first clinical nurse manager for the acutely unwell and deteriorating patient in Ireland. While in this role she secured a research master’s degree in nursing (2017) and a master’s in advanced practice nursing (2018) and developed the service. Her role is to aid the aversion of deterioration and admissions to critical care by supporting the identification, treatment, and management of patients who are at risk of deteriorating. She contributes to the development of clinical knowledge with education, support, and the tuition of critical care skills.

Dorothy Breen is a consultant in intensive care and clinical lead for quality at Cork University Hospital. She has previously worked as the director of education at the ASSERT simulation center at University College Cork and as a consultant in intensive care at Royal Prince Alfred Hospital, Sydney. She has been the principal investigator in Cork and Sydney for several multiclinical trials. Her interests include simulation, clinical communication, sepsis, and acute deterioration, as well as other aspects of quality and safety. Dr. Breen co-chaired the guideline development group for the National Clinical Guideline on Communication (Clinical Handover) in Acute and Children’s Hospital Services in Ireland.



Acutely deteriorating patients are entitled to the best possible care, which includes early recognition and timely appropriate intervention to reduce adverse events, unnecessary admissions to intensive care, and/or cardiac arrest.


To reduce the number of poor outcomes for surgical patients with a National Early Warning Score (NEWS) score ≥7 in our institution by 50%. A poor outcome was defined as:
1. Cardiac arrest
2. NEWS >7 not improving after 72 hours
3. Transfer to intensive care unit >6 hours


Surgical inpatients from a variety of surgical specialties (general, vascular, breast, colorectal, hepatobiliary, and plastic surgery) in a large university teaching hospital were included. Quality improvement tools were used to generate regular dialogue with the clinical teams, resulting in the concept of the surgical safety huddle being proposed. Deteriorating patients were highlighted at the daily huddle and a plan of early intervention was implemented. An incremental approach with continuous PDSA [Plan-Do-Study-Act] cycles and subsequent feedback was adopted on the surgical ward to develop the huddle. Poor patient outcomes were analysed prospectively via chart reviews.


Prior to the introduction of the “surgical huddle” 110 patients with NEWS >7 were audited. Twentyeight of these patients had a poor outcome at 72 hours (25%). Following the introduction of the surgical huddle supported by the deteriorating patient team, 64 patients with NEWS >7 were reviewed. Three of these patients had a poor outcome at 72 hours (4.7%). The introduction of the surgical huddle increased the interval between cardiac arrests more than sixfold on the surgical ward.


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