title: A reimagined discharge lounge as a way to an efficient discharge process.
abstract: Faced with inherent inefficiencies built into transfer of a patient from emergency department (ED) to an inpatient bed, we determined that the timely availability of an inpatient bed was essential to improving efficiency and flow. Lack of beds early in the day was a major cause for delays and backup in the ED, which in turn placed the ED at risk for overcrowding and diversion. Review of the discharge process revealed that only 33.4% of discharges were completed prior to noon, and on average took 126 minutes from the time a discharge order was written to the time the patient actually left their inpatient bed. To achieve our goals of improving patient flow and discharge efficiency, we proposed a new project, called the "Discharge Hospitality Center (DHC)." Our previous attempt at creating a "discharge lounge" was unsuccessful. However, we learned from that endeavor which then allowed us to completely redesign the new DHC project and incorporate ongoing feedback from all stakeholders, sharing performance metrics regularly, and collectively searching for ways to overcome barriers and improve performance together. Strict eligibility criteria were created, and every patient was screened for DHC eligibility daily at our multidisciplinary discharge planning meeting. This multidisciplinary group made the final decision about eligibility for the DHC, and took responsibility for distributing the list of eligible patients to the acute care nursing floors immediately after their early morning meeting. Using the list of patients appropriate for the DHC, the acute floor nursing teams developed standard work for prioritization of DHC eligible patients for discharge, which more reliably allowed those patients to leave their inpatient beds earlier in the day. We found there was no need for dedicated staff at our DHC, as after discharge all outpatient procedures and policies applied. Our outcomes were quite favorable. Four months after the DHC project was launched, ED stays over 6 hours decreased from 24.6 to 15.8%, discharges before noon increased from 33.4 to 41.5%, and time improved from 126 down to 84 minutes from the time a discharge order was written to the time the patients actually left their inpatient bed. We reviewed all patients who went to the DHC on the subject of readmission and found two that were unavoidable (whether or not the DHC was used), and one patient nearly missed his ride home as he sat in the wrong location for transport pickup. In conclusion, a DHC can be successfully designed through integration and collaboration with stakeholders which can be a valuable tool to improve discharge efficiency and patient flow.
authors.affiliation: Syracuse Veteran Affairs Medical Center, United States of America.
authors.forename: Natalia
authors.initials: N
authors.lastname: Hernandez
authors.affiliation: Syracuse Veteran Affairs Medical Center, United States of America.
authors.forename: Dinesh
authors.initials: D
authors.lastname: John
authors.affiliation: Syracuse Veteran Affairs Medical Center, United States of America.
authors.forename: Joan
authors.initials: J
authors.lastname: Mitchell