The Pearls and Pitfalls of Initiating a Neurosurgery Discharge Huddle: One Institution's Experience

Organized discharge huddles have been implemented in a number of specialties across medicine to improve communication and minimize medical errors that might ultimately harm patients. Literature has shown that disjointed care can lead to poor utilization of resources and suboptimal treatment. Conversely, effective and systematic coordination of care has been shown to improve quality of care, as well as a variety of other parameters. While huddles require time and effort from members of the staff, including physicians, nurses, pharmacists, and therapists, the benefits of improved communication and coordination of care are significant.

Discharge huddles have been shown to be effective in improving various metrics of patient care across multiple specialties. For example, a study investigating the effect of a multidisciplinary discharge huddle on a busy stroke service found that the huddle decreased length of stay by 1.4 d and that the number of patients who were discharged without necessary auxiliary services fell significantly from 47% to 35%. Another study showed that implementation of a physician-led multidisciplinary discharge huddle resulted in shorter length of stays (from 21.6 to 14.1) and decreased total hospital costs for patients hospitalized for subarachnoid hemorrhages. Implementing discharge huddles is a way to ensure that patients leave the hospital in an efficient manner and minimize any unnecessary delays.

The communication and planning that occurs during discharge huddles is aimed at streamlining patient care and preventing readmissions, which can be costly and detrimental to the patient. A study investigating unplanned 90-d readmissions following spine surgery at Vanderbilt University found that almost half of readmissions were due to pain and medical complications at median 6 and 12 d, respectively, while the other half were due to complications of surgery. The authors argued that the known timelines of the pain and medical complications allow for the opportunity to make postdischarge interventions that prevent readmissions. The effect of not having a routine discharge disposition, which would be installed by a discharge huddle, has also been studied. A database study of patients who had undergone a craniotomy for tumor resection found that nonroutine poor discharge planning led to higher rates of postdischarge complications and 30-d readmissions.

Patient satisfaction is a metric of patient care that can be somewhat controversial because patient demands can sometimes conflict with the most appropriate treatment algorithm. Indeed, there is evidence that satisfaction is not a strong proxy for the assessment of quality care. For instance, a multicenter retrospective review of 248 patients found that patient satisfaction correlated only mildly with health-related quality of life scores. There is contrasting evidence that patients who report their dissatisfaction with care actually experience more adverse events and medical errors, which may explain why patients are dissatisfied.

We previously described an improvement in hospital metrics (ie, length of stay, cost, and patient satisfaction) associated with the implementation of a daily 30-min morning discharge huddle at our institution. The goal was to have a structured daily conference including members from all disciplines of the care team to convene and discuss the discharge needs for all patients on the neurosurgery inpatient service. We found that certain inpatient costs decreased and that patient satisfaction scores improved following implementation of the huddle. In terms of costs, we hypothesized that having pharmacists and nurses present to recommend medication alternatives or point out unnecessary drugs likely helped reduce costs. We demonstrated an estimated savings of $1408 047.66 in the first 15 mo of implementation. With regard to improved patient satisfaction, we reasoned that patients were more likely to be satisfied with shorter lengths of stay and a more streamlined discharged process. Overall, the implementation of the huddle at our institution has demonstrated significant improvements in patient throughput as well as patient satisfaction. The authors will discuss pearls and pitfalls associated with the implementation of a neurosurgery discharge huddle to assist other centers planning to create a discharge huddle or improve the efficiency of their existing teams.