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Medical personel standing in a Tiered Huddle.
Improving Reporting Practices With Tiered Huddles

​​Event reporting is most effective if everyone knows what should be reported, there are no barriers to reporting, staff is encouraged to report, and there is proper escalation and follow-up from leadership on reported events. In response to inefficient reporting policies and practices that resulted in incomplete safety event responses, one health system introduced tiered huddles: a series of five brief huddles at the front line, unit/office, entity, region, and system levels. They also established clear escalation criteria and role delineation and visibility, requiring escalation for serious risks of harm to patients, team members, organization and/or infrastructure; barriers to execution of actions or countermeasures for identified risks or disruptions; and high visibility issues, including social media, patient experience, employee health or disaster-related conditions. A daily safety brief program is at the entity, or Tier 3 level, and occurs every day that the entity operates. As a result, in two months over seventy items were escalated for awareness or action, from the front line all the way to the system CEO, including critical census and staffing issues, a cardiac catheterization lab being out of service, slowness of computed tomography (CT) images transmitting through the picture archiving and communication system (PACS) potentially delaying diagnoses, and concerns about how to mitigate COVID-19 spread.