by @BenAzan

Say Something Ed


Over the last several months, the Mount Sinai Emergency Department has been implementing TeamSTEPPS to improve the workflow, communication and operations in the Emergency Department.

What is TeamSTEPPS? It’s essentially a nomenclature for team training and teamwork. It was put together by Agency for Healthcare Research and Quality (AHRQ). It’s a set of terms and approaches that can be implemented by clinical teams to reduce errors and, hopefully, improve outcomes. Snake oil right? Well, preliminary data show some success in trauma (1,2), generally in emergency medicine (3) and has been applied in many other hospital settings (4).

While I (@BenAzan) am usually quite skeptical of these kind of ‘soft’ activities, I think there are some clear advantages to implementing this approach.

  • First, it enables staff to use a common vocabulary and framework to approach difficult or crisis situations, reducing the likelihood of miscommunication.
  • Second, in a effort to counter medicine’s hieratical structure, TeamSTEPPS training empowers team members in all echelons to bringing up issues that might have otherwise not been spotted.

So today, let’s go over one specific part of the TeamSTEPPS approach:

CUS words

This is a silly acronym for: Concerned, Uncomfortable and Safety. 

Screen Shot 2015-01-02 at 12.55.39 Pm

Much like the safety words used for other purposes, providers should use these words to bring up an event that they would like to flag in a serious way. Once an emergency department is on board with teamSTEPPS, saying one of these key words will trigger a red flag with the listener. Using the “Safety” word should trigger a hard stop to the current activity and a quick re-evaluation by the team before proceeding.

More handy tips will be given during the twice daily team briefs, so stay tunes for continued little tidbits.


1. Harvey, Ellen M., et al. “TeamSTEPPS (®) simulation-based training: an evidence-based strategy to improve trauma team performance.” Journal of continuing education in nursing 44.11 (2013): 484-485.

2. Capella, Jeannette, et al. “Teamwork training improves the clinical care of trauma patients.” Journal of surgical education 67.6 (2010): 439-443.

3. Turner, Pamela. “Implementation of TeamSTEPPS in the emergency department.” Critical care nursing quarterly 35.3 (2012): 208-212.


May 2024