Abstract
Background
Communication failures among healthcare professionals are a leading contributor to patient harm. At Nemours Children’s Hospital, Delaware, proactive safety huddles—termed “pre-swarms”—were introduced to prevent central line–associated bloodstream infections (CLABSIs) and promote enhanced communication amongst the members of the multidisciplinary care team.
Objectives
To develop and implement a proactive, multidisciplinary bedside huddle process aimed at identifying and mitigating CLABSI risk factors before harm occurs.
Methods
Using common cause analysis of apparent cause analyses, the Harm Prevention and CLABSI leadership teams created a structured pre-swarm form. This tool guided bedside discussions, identified patient-specific risks, and facilitated timely interventions. The process evolved to include standardized conversation frameworks, stakeholder engagement, and follow-up mechanisms. Pre-swarm summaries were shared hospitalwide to promote learning and continuous improvement.
Results
In 2024, 49 pre-swarms were conducted, surpassing the goal of 25. None of the patients who underwent a pre-swarm developed a CLABSI. The hospital’s CLABSI rate decreased from 1.30 in 2023 to 1.10 in 2024 (15.4% reduction) and decreased again by 43.7% from the end of 2024 to Q3 2025. The initiative fostered a cultural shift toward shared accountability and proactive harm prevention.
Conclusions
The implementation of the pre-swarm model coincided with reductions in CLABSI rates and enhanced multidisciplinary collaboration. These observed benefits supported its expansion across other harm indicators and high-risk patient populations, reflecting its adaptability and impact on patient safety culture.
Plain Language Summary
Much of the focus in patient safety is on preventing adverse events, and we know that communication problems in healthcare are a major contributor to patient harm. So, rather than reactive “swarming” around a patient following an event to review what happened, Nemours Children’s Hospital in Wilmington, Delaware, adopted proactive safety huddles, which promote open communication and collaboration by bringing together multidisciplinary members of the care team to discuss potential safety risks for patients
before
something goes wrong.
The Harm Prevention team developed their initial “pre-swarms” around reviewing patients at risk of central line–associated bloodstream infections (CLABSIs), working with CLABSI leadership and a taskforce to reduce the hospital’s CLABSI rates. Through common cause analysis, they identified CLABSI risk factor criteria which would trigger a pre-swarm for a patient, as well as proactive strategies—closing process gaps and introducing procedures to prevent infections. After the pre-swarm trial in a neonatal intensive care unit (NICU), they reviewed 49 patients in 2024, none of whom experienced an infection, and the hospital’s CLABSI rate decreased by 15.4%. Pre-swarming through third quarter 2025 further reduced the rate by 43.7%. The hospital has since expanded pre-swarms to review patients at risk for other harm criteria and forms of harm.