Newman's Notions | April 26, 2023 | FREE
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Huddle up

Hospital huddles are just the latest iteration in a long tradition.

I love a good hospital census huddle. Three times a day on weekdays and twice daily during the weekend, I am on that Zoom meeting or sitting there in person. There are only a few people at my work who have a better attendance track record than I do, most notably my colleague Ken, who is a confirmed fellow huddle-phile. I think on weekends he may go into slight withdrawal without his 2:30 p.m. huddle fix.

What, you ask, is so great about a census huddle?

The ideal huddle is short and sweet but covers so many questions. What is going on in the hospital and in the health system itself? Where are the bottlenecks? How busy is the emergency department? How many scheduled surgeries are there today? What is the bed turnover time by environmental services? Is there adequate nurse staffing? How many discharges are predicted? Do we need to place the hospital on diversion?

The huddle also allows for discussion of emergencies that don't rise to the level of a Hospital Incident Command System event, such as purple water running in an old building's toilets or a local nursing home losing power. It's all about situational awareness, transparency, collaborative communication, and solutions.

Illustration by David Rosenman
Illustration by David Rosenman

It is perhaps ironic that the word huddle comes from the 16th-century German word hudern, which means “to crouch together, to conceal.” That creates visions of huddling together by a fire to stay warm or huddling in a closet in fear of an intruder. A huddle can also be a formation to conceal communication, most notably in football.

The legend of the origin of the football huddle involves Paul Hubbard, who was the quarterback at Gallaudet College, a private school for hearing-impaired and deaf students. Their football team was a little over a decade old when he became the quarterback. He had his teammates huddle around him to hide play signs from the view of an opposing team who could also read American Sign Language, and it soon became a standard practice. True or not, it's a great story. And if you watch a football game on television, you'll see the coaches covering their mouths to prevent lip reading!

Sometimes teams implement a no-huddle offense in football, but that's rarely a good idea in census management. In contrast to the secrecy behind the football huddle, the hospital huddle is meant to provide open communication about situational status and multidisciplinary decision making.

Last Saturday afternoon I was feeling a Minnesota Chill coming on, so I called Ken to let him know we desperately needed to huddle. Alarmed, he peppered me with questions: Was there a census emergency? Were the toilets flooding? Was the power out? Was a blizzard coming? I told him it wasn't a census huddle, and I wasn't crouching in my closet in fear of a upcoming Joint Commission survey.

It was just cold and snowy and I was huddled by the fire. I sensed a little disappointment from him that there was no emergency huddle needed, but he did agree to bring some wood for my fireplace.

Attending Internal Medicine Meeting 2023 in San Diego? You'll have two chances to huddle with Dr. Newman in the ACP Resource Center, Booth 1131 of the Exhibit Hall. He'll be delivering two 10-minute talks on “Hot Topics in Hospital Medicine” at 10:50 a.m. on Thursday, April 27, and 12:50 p.m. on Friday, April 28.