02: Huddle Dynamics

Vicky Muller

Alright, welcome back to Starting Strong! Today we're diving into huddle dynamics—how to actually make those interdisciplinary care huddles work for you, not against you. I’m Vicky Muller, and I’ll be honest, my first huddle as an attending was... let’s just say, a little chaotic. I remember walking in, everyone looking at me. I had been actively speaking in huddle as a resident but never got much feedback about the process. Now as the attending, who starts the huddle? Was it me? The nurse? The case manager? I just started talking about the first patient they brought up, and then realized halfway through that I was basically giving a mini-grand rounds. Not the point of a huddle, by the way.

Beth Blimmer

Oh, I love that, Vicky. I think a lot of us have been there! So, just to set the stage, huddles are these short, focused meetings—usually daily—where the whole care team comes together to talk about discharge planning and care coordination. The goal is to keep everyone on the same page and move patients forward safely and efficiently. And the team is more than just doctors and nurses, right?

Mark Krause

Yeah, exactly. You’ve got Nurse Case Manager, or NCM, who’s handling stuff like home health, IV antibiotics, home hospice, outpatient therapies, all that logistical magic. Then Social Work Case Manager, or SWCM, is your go-to for placement—like a sniff or rehab—plus financial resources, transportation, and substance use support. Pharmacy’s may be there for med rec and discharge meds, therapists for mobility and rehab needs, nursing for bedside readiness, and of course, us--the physicians. But, and this is key, the physician doesn’t lead the huddle. We’re there to give succinct updates—like, “Estimated Discharge Date (EDD) is Friday, just waiting on MRI”—and flag any barriers that aren’t obvious in the chart.

Vicky Muller

Right, and I think that’s where a lot of new attendings get tripped up. You’re not there to run the show, you’re there to collaborate. The case managers usually leads because they know the pathways for arranging services and placement. Our job is to keep it brief, highlight milestones, and make sure we’re advocating for timely, safe discharge.

Beth Blimmer

So, let’s talk about what not to do. I mean, I’ve definitely seen huddles turn into extended rounds, where someone starts reciting the entire medical history. That’s not what this is for! You don’t need to share every lab value or imaging result—just the stuff that actually impacts discharge.

Mark Krause

Oh, totally. And, uh, I gotta admit, I sometimes mix up the social work and nurse case managers. I thought the social worker was handling a home health referral, so I kept bugging them about it. Turns out, that’s Nurse Case Manager's job. That can lead to a wild goose chase if messaging the wrong person. Luckily the social worker redirected me so we got the orders signed and did not miss the home health start date. So, yeah, know who does what!

Vicky Muller

That’s a classic, Mark. And it’s not just about knowing roles, it’s about being prepared. Come in with your estimated discharge date—like, “likely Friday, awaiting MRI”—and anticipate what social or functional needs might come up. If you’re not sure, ask! And if you see a barrier, like insurance or rehab eligibility, bring it up early. Delays cost everyone, especially the patient.

Beth Blimmer

And don’t be afraid to speak up if you notice something that isn’t in the chart. Sometimes the most important info is what you learn from talking to the patient or their family. But keep it brief—one or two sentences, max. The huddle isn’t the place for a full clinical review. As the physician, you are likely first line for some important information. As you are updating the patient, they--or family--may clue you in to concerns about things like insurance coverage or medication cost.

Mark Krause

How do you all handle situations where everyone on the team can't be at huddle. For example, sometimes a nurse is busy with a patient need and they are the one with the patient that has the most updates?

Vicky Muller

It's all about carving out a few more minutes to make sure things are clear. If that nurse cannot be there, just find them and talk to them about the updates. Similarly, I know that going from big resident rounding teams to rounding on my own, I realized I didn't have a rounding pharmacist for rolling updates with each patient. So, huddles are a good time to really sit down and make sure the medications are being reviewed. I usually have a small one-on-one with them after huddle just for meds. Pharmacy usually has their notes so I let them just go down their list-medication changes, medication concerns, discharge medications, cost of medications-whatever they need.

Mark Krause

So, how do we make huddles actually work, and not just become another meeting everyone dreads? One thing that’s helped is using a standardized checklist. That way, you hit all the key points—EDD, barriers, follow-up needs—without getting lost in the weeds. It keeps things moving and makes sure nothing gets missed.

Vicky Muller

Yeah, and I’ve seen teams rotate the facilitator role, too. It’s usually the NCM, but sometimes letting someone else lead—like a social worker or even a physician—can keep people engaged and give everyone a sense of ownership. It also helps you appreciate what each role brings to the table.

Beth Blimmer

And don’t forget about feedback. I love when teams schedule regular check-ins to talk about what’s working and what’s not. Sometimes you realize you’re missing the same thing over and over, or maybe the huddle’s running too long. Getting everyone’s input helps you tweak the process and keep it sustainable.

Mark Krause

Yeah, and honestly, when you see the impact—like fewer discharge delays or better communication—it makes it worth sticking with. Plus, it’s a great way to build team morale. I mean, who doesn’t love a good “shout-out” when things go right?

Vicky Muller

Let’s talk tech for a second. There are some great tools out there now—like EHR-integrated checklists that auto-populate with the latest labs, consults, and discharge needs. That cuts down on manual entry and makes sure everyone’s working from the same info. At our institution, you can wrench in the estimated discharge date column and the physicians can even type in what the barriers are. I did this and it cuts down on questions because people know what I'm thinking and can look it up.

Beth Blimmer

And real-time analytics dashboards! I get a little nerdy about this, but being able to see where discharge delays are happening—like, is it always waiting on a rehab bed, or pharmacy, or insurance?—lets you actually do something about it during the huddle, not after the fact.

Mark Krause

Plus, don’t underestimate the power of a good communication app. Secure messaging platforms let you update the team instantly if something changes after the huddle. It keeps everyone in the loop, especially when you’re juggling a bunch of discharges at once. I mean, I’m still waiting for the day when we have a “discharge huddle” button in the EHR, but we’re getting closer.

Vicky Muller

Yeah, and the more you can automate and streamline, the more time you have to actually care for patients instead of chasing down paperwork or playing phone tag.

Beth Blimmer

Alright, let’s get into some real-world cases. First up, the classic: 87-year-old woman, just had a hip disarticulation for a prosthetic joint infection, needs six weeks of IV antibiotics. Mark, what are you thinking in terms of information needed for the huddle?

Mark Krause

The key here is making sure you know when the antibiotics end, who’s following the labs, and what kind of IV access she has. Is she going home and needing inpatient rehab as this will change who is overseeing the process. Be clear such as "therapy recommendations home with Home Health. She will need six weeks of IV antibiotics with end date October 3rd. Infectious Disease will be monitoring lab work. Medically she is ready to go tomorrow following PICK line placement and teaching."

Vicky Muller

Next patient—24-year-old with IV drug use and MRSA endocarditis, planned for IV antibiotics.

Mark Krause

Tough one. The discharge may start with the same discussions about home health and IV antibiotics. But this is tricky because of the risk of PICK misuse. I might update the team that we need to bring in Physician Advisors early, and really weigh the risks and benefits. Sometimes keeping the patient inpatient is safer, but it’s a big cost, so you need the whole team’s input.

Vicky Muller

Beth, you're up.--a patient with cognitive impairment. A 67-year-old guy with frequent DKA, lives alone, and you’re not sure if he can manage insulin at home. You are worried the DKA is from not understanding his insulin regimen or not having access to supplies.

Beth Blimmer

That’s when you pull in case management, diabetes education, and pharmacy to make sure he’s set up for success. You may end up talking very little at huddle about the medical needs and mostly on these benchmarks to avoid readmission. I had a patient like that once—her social needs were so complex, I thought I had it all figured out, but then a social worker pointed the patient was having a very tough time reading the discharge location list and brought that to our group. Turns out a big part of the insulin challenges were being able to simply read the insulin pens. Sometimes the best thing you can do is listen and learn from your team.

Mark Krause

Yeah, and that’s the beauty of huddles. You’re not supposed to have all the answers—you’re supposed to bring your piece and trust the team to fill in the rest.

Vicky Muller

Exactly. So, to wrap up, remember: huddle is a team sport, not a solo act. Know your roles, prep your talking points, and use your voice to advocate for your patients. And hey, keep learning from each other. That’s how we all get better.

Beth Blimmer

Thanks for joining us, everyone! I’m already looking forward to our next episode. Mark, Vicky, always a pleasure.

Mark Krause

Yeah, this was great. See you next time, and don’t forget—keep those huddles short and sweet!

Vicky Muller

Take care, everyone. Bye!