Attention: ED manager now in the huddle . . .

An "administrative huddle" at Latter Day Saints (LDS) Hospital in Salt Lake City has been tremendously helpful in determining when to postpone elective surgeries, but it has had a much broader impact on patient flow in the ED and the hospital as a whole.

In 2002, the hospital instituted daily administrative huddles. "The huddle reviews events and patient-flow information from the previous day," explains Mike Gibbons, RN, BSN, the ED nurse manager. "The nursing supervisor reviews census data, and the group evaluates the day’s planned admissions to verify that enough beds are available."

The huddle attendees include the nursing supervisor, the ED manager, the surgery manager, and the administrative directors for cardiovascular, neuromusculoskeletal, women’s and newborn, trauma, and surgery services.

Daily ED involvement in these huddles is very significant; otherwise, they get overlooked, Gibbons adds. "Typically, the ED is the last place people think of as part of the hospital," he says.

"This helps us be part of the mix, and for other departments to understand that a large percentage of their admissions come from us." If the ED is not taking into account when the hospital is full, says Gibbons, "something will break somewhere."

The administrative huddle idea has caught on so well at LDS that is has expanded to a charge nurse huddle, which takes place at 4 a.m. and 11 a.m. daily, to discuss critical staffing needs. "This huddle provides the ED charge nurses with information about bed availability times and staffing issues on various floors and ICUs," says Gibbons. "This information is then used by the ED charge nurses to better manage their resources — knowing, for example, that they may need to hold several patients until the usual afternoon discharges are completed on the acute care floors."