What Two Factors Drive Huddles?

Generically, hospital multidisciplinary rounds, or “huddles” (I will use these terms interchangeably throughout the article) should occur at a consistent time and location for attendees to discuss patients’ discharge plans or progression of care needs. The true success of rounds relies on two factors: collaboration and accountability. 

Just consider how often the following scenarios occur. Unit-based huddles take place with nursing, case management, and the physician advisor; however, the attending physician is absent because “they just can’t make it work.” Maybe their assignments are not unit-based, and thus they are  on one unit when their patients are throughout the hospital (not at all conducive to rounds).

The second scenario is when the physician is in attendance, but they come in and run their list of patients while everyone else in the room listens. The physician must then direct the team for responses regarding patient care needs or discharge planning needs. In this case, it is not uncommon that the physician or hospitalist group has been “voluntold” that they are required to attend this daily meeting, in an effort to speed up the discharge process. In both cases, the value of the huddle to the physician is evident – minimally useful, meaning that in some cases, they find a way to completely avoid the process. 

Collaboration

When rounds are rolled out, I typically see a list of items that “should be covered;” however, I rarely see a discussion with each stakeholder group that dives into the value and worth of rounds to each discipline. The goal of rounds is to get all attendees on the same page, ensure an inline approach for patient communication, and share relevant information with an outcome of reduced intrusions throughout the day. The physician does not want to attend rounds, leave, and then get multiple texts, phone calls, and secure chats from the very same groups that attended the rounds.

Through a collaborative process, the care team can identify the intention of rounds – discuss all patients for updates and progression of care, or only focus on up-and-coming discharges for preparations. In this case, the topics for discussion will be slightly different. A simple way to ensure that each member identifies his or her role in rounds would be to follow the “plan” approach:

• Plan for the Stay (Physician);
• Plan for the Day (Nursing);
• Plan for the Way (Case Management);
• Plan for the Pay (UR/UM, Physician Advisor); and
• Plan for the Say (message to patients).

Accountability

Once the purpose of rounds or huddles is established, the next piece of the puzzle is to guarantee accountability of the stakeholders involved. Such phrases as “it’s my first day on” or “I didn’t review any of my patients yet, I just got here” are counterproductive to the process. On any given day of the week, it is each person’s first day on – that is why the rounds exist, to help each member get up to speed, so they do not have to start from scratch and reinvent the care plan. Thus, coming to rounds is critical; case managers or charge nurses that have not reviewed their patients or talked to their floor nurses for reports is unacceptable. If it is not possible to accomplish it in the morning, by the time rounds occur, move the meeting to a later time, when everyone can guarantee they are prepared.

During rounds, follow-up items and information is collected among the members; this may be to order changes or “to-dos” for the group. When members leave rounds, the expectation is that these items for follow-up will be completed. This ensures that the only further intrusions later in the day are new discoveries or changes to the patient plans of care.

Collaborative multidisciplinary rounds create the opportunity to enhance patient outcomes through coordinated approaches and optimized treatment plans. Although the team is moving in different directions throughout the day, from the patient’s perspective, the care team is all aligned, and making them feel safe in their plan of care. The team understands each member’s role and contributions in the care delivery process and is accountable to the collective success of the group. That connection develops at rounds or huddles, with each member understanding their role, their objectives, and how they are being held accountable for their deliverables.

Programming note: Listen to Tiffany Ferguson report this story live today during Talk Ten Tuesdays, 10 Eastern, with Chuck Buck and Dr. Erica Remer.