• Led by the Royal College of Paediatrics and Child Health, in partnership with UCL Partners Academic Health Science Network, WellChild, Anna Freud Centre and the Institute of Child Health.
  • Implemented at 28 specialist children’s hospitals and district general hospitals across England.
  • Aimed to improve outcomes for acutely unwell children on paediatric wards, and reduce variation in service delivery quality.
  • Used the clinical huddle method to improve situational awareness and facilitate improved communication.

Outcomes for acutely sick children in paediatric care in the UK are significantly worse than those for children in other countries, and for children in the NHS versus adults in the NHS. This project aimed to improve outcomes for these children, using situational awareness and improved communication.

It involved trialling models of care, including the ‘huddle’ technique: a 10-minute exchange of key information between clinical and non-clinical professionals involved in a patient’s care, using specific tools to ensure its consistence and validity. The huddle encourages information sharing and equips professionals with skills to spot when a child’s condition is deteriorating.

The Situation Awareness For Everyone (S.A.F.E) programme brought together paediatric units from 28 sites. Each ran a quality improvement project, focusing on a particular aspect they wanted to improve.

Evaluation of the project was carried out by the Anna Freud Centre and explored how and to what extent increasing situation awareness can lead to improved safety, experience and quality for children. A mixed methods approach was taken, including interviews with parents, patients and staff, observations of huddles, and analysis of safety indicator data.

The evaluation provided essential learning on the implementation of huddles and their potential impact. While no obvious pattern in outcome measures, such as cardiac arrests and transfers to ICU, could be discerned, there were clear examples of the benefits of implementation, particularly in terms of staff communication, teamwork, organisation and efficiency, and awareness of patient safety and safety issues.

Some sites had challenges with implementation, particularly around lack of involvement of groups of staff, and there was clearly variation in how embedded the huddle methodology was across the sites. Commonly cited barriers included lack of leadership and ownership, and lack of perceived fit between the methodology and the way that the ward works.

There was a clear will to continue to embed and spread S.A.F.E practices following the programme, and many teams were confident that evidence of its benefits were emerging from their locally collected improvement data.

As a result of the S.A.F.E programme, a clearer model for implementation has now emerged for the use of huddles in UK paediatric settings. In many of the S.A.F.E sites, the huddle methodology has become embedded in its ‘business as usual’ and spread to other paediatric wards.

The programme will continue to be overseen by the RCPCH Quality Improvement team, who will keep the online resource pack up to date.

Contact details

For further information about the project, please email Kasia Muszynska, RCPCH.

About this programme


Closing the Gap in Patient Safety


This programme ran from 2014 to 2017, and offered funding for projects to implement and evaluate...

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