Why Pre-Op Huddle Sucks

The pre-op surgical team huddle is a game-changer. It is also impossible to sustain.

Maya Ber Lerner
4 min readFeb 14, 2022

An overwhelming majority of surgical team members report communication challenges

We talked to 90 perioperative clinicians and stakeholders. Nurses, anesthesiologists, surgeons, scrub technologists, vendor reps, intra-op monitoring, residents, fellows. Over 94% reported challenges with perioperative communication. These challenges result in miscommunication errors, delays, waste and stress. They also impact patient outcomes.

Surgery is a team sport, and perioperative team communication is a critical factor in surgical efficiency and quality. Making sure all the stakeholders involved in a case are 100% aligned sounds simple. Can’t everyone just.. talk?!

Huddle? Yes please

Huddle (aka briefing) is a team meeting that includes the entire surgical team. It is performed before the procedure (pre-op), typically in the morning, before the first case. The huddle provides a standard approach to assuring everyone on the team is familiar with the plan, can ask questions, identify potential problems and set expectations. This helps to create a shared mental model for the entire team.

There are dozens of studies on surgical team communication interventions. Huddles and briefings have been consistently producing outstanding results. Check out this 2015 study, that compares the result before and after implementing a pre-op huddle. The table below summarizes the results.

The rate of unexpected delays per day goes down from 79% to 21%.

The number of questions asked by the team goes down from 2.5 to 0.5.

The overall surgeon rate to the day’s flow (from 1 to 10) improves from 5.6 to 8.

The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon satisfaction in an orthopedic operating room. Table 1 compares the results from baseline and huddle implementation observations.

Here is another research that was published in January 2022 in the British Journal of Surgery. This multi-center study of 7,745 surgeries showed impressive reduction in mortality, unplanned reoperations and prolonged hospital stays as a result of surgical team briefings.

This is amazing.

Huddle? No, thank you

If it’s so amazing, why doesn’t everyone do it? Because the effort is unreasonable. The huddle implementation is impossible to sustain.

There are too many stakeholders from very different and siloed teams. Some stakeholders are external (for example, medical device company representatives or outsourced intraoperative monitoring and navigation services).

In many cases the team assignment is not even known until the morning (it is very common that a surgical booking only says who the surgeon is).

Not everyone on the team has to otherwise be in the room at the same time.

Sometimes, the team changes throughout the day (a new shift, team members move between operating rooms and more).

No one on the team is a desktop employee. Everyone runs around and is already stretched thin. And their schedule is full of unexpected emergencies.

Although everyone wants the best results, not everyone gets immediate value from the huddle, and it’s hard to align everyone’s incentives.

The worst thing is that the first case in the OR typically needs to start at 7:30am. This means that everyone has to be in one room at about 7am for a huddle to happen.

Figuring out the huddle

How to make the huddle and other continuous improvement practices sustainable?

  • It needs to be virtual — getting everyone to the same room in person sounds ideal, but it is not realistic. A virtual huddle makes it possible for more team members to consistently participate.
  • It needs to be asynchronous — it’s much easier for everyone on the team to find a couple of minutes if it doesn’t have to be the coordinated with a dozen other busy professionals.
  • It needs to happen earlier — an early morning huddle doesn’t give everyone on the team enough time to prepare. Getting everyone on the same page the evening before cases makes a difference.
  • It needs to be high-context — different cases require a different huddle. The huddle needs to be customized for each case and for each team member.
  • It needs to take under a minute — even if the actual team alignment is quick, getting 10 people in the same room (or zoom) at 7am would never be fast enough. It needs to be much faster.

🧠 If you believe huddles are important but implemented wrong, and you are looking for an alternative, let’s talk.

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