MOSHI 2: An exploration of key safety concerns, mitigations and adaptive capacity arising from the use of safety huddles in ICUs across the United Kingdom - A cross-sectional national e-survey.

OBJECTIVES: This cross-sectional survey study aimed to explore key safety concerns and mitigations arising from safety huddles in adult Intensive Care Units (ICUs) in the United Kingdom. METHODS: An anonymous electronic survey was structured around the System Engineering Initiative for Patient Safety 2.0 human factors framework to capture huddle content, risks, and mitigations from responses. Data included unit demographics, and qualitative insights were analysed using framework analysis. Risk mitigations were further analysed and mapped to the Coordination and Accountability for Resilience and Effectiveness (CARE) model, which highlights four components of resilient healthcare: anticipating, monitoring, responding, and learning. The study is reported against the CHERRIES checklist and registered Hospital Trust Ulysses 9941. RESULTS: The study included 74 ICUs. Over 95% (71/74) of ICUs reported conducting a safety huddle, but 75% (53/71) did not use an established framework. A total of 234 frequently reported safety concerns were described. Most common were staffing risks (10%, 23/234), alongside issues related to tissue viability 19/234, 8%), capacity (17/234, 7%), infection control (17/234, 7%) and other specialist risks such as pacing or difficult airways (15/234, 6%). Over half of responding units did not involve clinical governance in their huddle and two thirds did not share learning nationally. Most reported mitigations mapped to responding, and less frequently to anticipating, monitoring and learning. CONCLUSIONS: This survey reveals that while most ICUs conduct safety huddles, few use evidence-based frameworks and most mitigations were reactive. IMPLICATIONS FOR CLINICAL PRACTICE: This study emphasises a need to further develop the ICU safety huddles process. Our work indicates that establishing an adaptable evidence-based huddle framework, investing in strategies to increase anticipating, monitoring and learning from huddle content and formalising digital solutions to capture huddle data will enable dynamic organisational learning and safety progress.