Improving throughput or patient flow of timely discharges can positively impact patient safety and satisfaction. A large metropolitan level-1 trauma center with a 530-inpatient bed capacity with a daily census of 103% capacity implemented a hospitality suite, the discharge lounge, in 2015. Common practice was for staff to refer patients to the discharge lounge. Initial metrics demonstrated low utilization of the discharge lounge; the average volume of patients per month was 51.
2016 hospital leadership tasked the Gonda observation unit to reimagine the discharge lounge to meet the needs of patients with discharge orders that remained in a hospital bed. Gonda observation unit collaborated with hospital leadership, bed control, case management, and front-line staff on non-ICU medical-surgical units through focus groups and surveys. Re-evaluation of the process in March of 2016 resulted in implementing a proactive discharge lounge strike team. Barriers to discharge were identified, systematic interventions were formulated, and a policy for the inclusion criteria and scope of practice for the discharge lounge was implemented.
The discharge strike team was staffed with two full medical-surgical registered nurses that could deploy to the bedside, review the after-visit summary; clarify appointments; discharge medication; and provide bedside teaching for management of surgical drains, urinary catheters, central line dressing care, peripheral intravenous catheter removal, facilitation of discharge medications, and medical equipment delivery. Discharged patients were escorted to the discharge lounge or valet drop-off. The discharge lounge offered concierge services for discharged patients, including assistance for meals when waiting in the discharge lounge for ride pick-up, taxi, or UBER assist, and an opportunity for just-in-time service recovery.
Organizational leadership initiated a daily census alert of the green, yellow, and red census. The yellow census indicated patients were at risk for boarding in the pre-operative care unit and emergency room. The red census put the emergency service at risk for diverting patients. Yellow or red census alerts triggered a system-wide response to identifying barriers to discharge. Bed control partnered with the discharge strike team and lead nurses to strategically identify and discharge patients that met the criteria for the discharge lounge. Collaboration of stakeholders for discharge and utilization of the discharge strike team demonstrated a 35% improvement of throughput in the emergency room.
The volume of facilitated discharges average per month increased from 51 in 2015 to 434 in 2018. The discharge lounge strike team expanded staff and services in 2019, operating seven days a week with four full-time medical-surgical registered nurses. In 2020, COVID-19, an unprecedented pandemic, impacted hospital census and the need for open beds with emergency surge capacity and urgent admissions of COVID-19 patients who would otherwise be admitted through emergency services. The optimization of the discharge lounge strike team of facilitating discharges and urgent admissions of low- and high-suspicion COVID-19 patients significantly impacted throughput, patient safety, and satisfaction as volume discharges expanded to average of 586 per month and average volume of facilitated admission of 85 per month in 2020.