Ethan Rhodes
Hospital discharge lounges, or DHCs, have been implemented to improve patient throughput and efficiency. While they are generally endorsed as a mechanism to accelerate access to inpatient beds, there is limited evidence regarding their impact on hospital readmission rates. A study comparing readmission rates between patients discharged from a DHC and a control group found no significant difference in readmission rates between the two groups. However, the use of discharge lounges can help reduce boarding times in emergency departments by providing a space for discharged patients to wait for transportation, freeing up inpatient beds, and improving patient flow.
| Characteristics | Values |
|---|---|
| Purpose of Discharge Lounges | To improve patient throughput and flow, and discharge efficiency |
| Impact on Readmission Rates | No significant difference in readmission rates between control group (9.74%) and DHC group (9.93%) |
| Other Benefits | Reduced ED stays over 6 hours, increased discharges before noon, improved time from discharge order to patient departure, reduced wait times for patients in hallway beds, reduced clerical work in discharge process |
| Challenges | Underuse, care team objections, lack of staff education, inadequate patient screening, sustainability concerns, location and design issues |
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What You'll Learn
Discharge lounges can reduce wait times for inpatient beds
Discharge lounges, or DHCs, have been developed to improve patient throughput and flow. They are designed to reduce wait times for inpatient beds and improve the efficiency of the discharge process.
DHCs allow patients who have been discharged from the hospital to wait in a designated lounge for their transportation home. This frees up inpatient beds and reduces the time it takes for newly admitted patients to access a bed. This is especially beneficial in emergency departments, where boarding and crowding can have deleterious effects on patient safety.
The implementation of a DHC at the Syracuse Veteran Affairs Medical Center in New York resulted in a decrease in ED stays of over 6 hours, from 24.6% to 15.8%. Additionally, the number of discharges before noon increased from 33.4% to 41.5%, exceeding the goal of 40%. The time from the writing of the discharge order to the patient's departure from the inpatient bed was also reduced from 126 to 84 minutes.
UAB Medicine also implemented a discharge lounge to reduce boarding times and improve patient care. The lounge helped to free up hospital rooms for incoming patients and reduced the average boarding hours. However, in June 2022, the main ED experienced a record number of patients boarding, indicating that further strategies may be needed to manage high-capacity concerns.
While discharge lounges can help reduce wait times for inpatient beds, it is important to note that their effectiveness depends on various factors, including location, staff education, patient eligibility screening, and sustainability.
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They can help improve patient flow and discharge efficiency
Discharge lounges or Discharge Hospitality Centers (DHCs) have been developed to improve patient throughput and flow, and discharge efficiency. They can help patients who have been discharged from the hospital but are waiting for transportation to vacate their inpatient rooms, freeing up space for new patients or for rooms to be cleaned.
The implementation of discharge lounges can help reduce the "boarding" of patients in the emergency department (ED). This boarding is often the result of high occupancy rates and ED overcrowding, which was exacerbated during the COVID-19 pandemic. By moving patients who are awaiting transportation to a discharge lounge, hospitals can reduce wait times for patients in hallway beds or boarding in the ED.
UAB Medicine's nursing leadership successfully implemented a discharge lounge to address this issue. They reported that the percentage of ED patients staying for over 6 hours decreased from 24.6% to 15.8%, discharges before noon increased from 33.4% to 41.5%, and the time from the submission of the discharge order to the patient's departure decreased from 126 to 84 minutes.
While the evidence for the effectiveness of discharge lounges is limited, with only a few peer-reviewed articles available, they are widely endorsed as a mechanism to accelerate access to inpatient beds and improve patient flow and discharge efficiency. However, further rigorous investigation is required to maximize their impact on hospital-wide patient flow and ED boarding.
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They can reduce ED boarding and crowding
Discharge Hospitality Centers (DHCs) or discharge lounges in hospitals have been developed to improve patient throughput and flow. They can be valuable tools to improve discharge efficiency and patient flow.
DHCs can reduce ED boarding and crowding by allowing patients who have been discharged from the hospital but are waiting for transportation to move to the DHC, freeing up hospital rooms to be cleaned and prepared for other patients. This can reduce the time from the submission of the discharge order to the time the patient leaves the hospital. For example, at the Syracuse Veteran Affairs Medical Center, ED stays over 6 hours decreased from 24.6% to 15.8%, and discharges before noon increased from 33.4% to 41.5%. The time from the discharge order to the patient leaving their inpatient bed improved from 126 to 84 minutes.
Additionally, creating a discharge lounge can help reduce the "boarding" of patients in the ED, which is caused by factors such as high occupancy rates. During the COVID-19 pandemic, capacity concerns and ED overcrowding were significant issues. By moving discharged patients to a special location while waiting for their transportation, wait times for patients in hallway beds or boarding in the ED can be reduced.
However, it is important to note that the design and implementation of discharge lounges vary, and further rigorous investigation is required to maximize their effect on ED boarding and crowding. Common barriers to discharge lounge performance include underuse and care team objections.
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They can help patients who are waiting for transportation home
Discharge lounges in hospitals are dedicated areas where patients who no longer need direct hospital services can wait for their transportation home. They are designed to provide patients with amenities such as seating, snacks, beverages, and entertainment, such as TV, while they await their ride.
These lounges help patients who are waiting for transportation home by providing them with a comfortable and supervised space to wait. They also free up hospital beds and rooms for patients who need to be admitted, reducing overcrowding in emergency departments (EDs) and improving care efficiency. This, in turn, helps hospitals expedite inpatient bed availability and reduce wait times for patients in hallway beds or boarding areas.
For example, at the Syracuse Veteran Affairs Medical Center in New York, the implementation of a discharge lounge decreased ED stays over six hours from 24.6% to 15.8%, and discharges before noon increased from 33.4% to 41.5%. Additionally, the time from when a discharge order was written to when patients left their inpatient bed improved from 126 to 84 minutes.
To ensure the effective use of discharge lounges, hospitals should establish eligibility criteria and clear transfer processes for staff to follow. This includes determining whether patients are alert and oriented, can ambulate independently or with minor assistance, require no additional wound care or oxygen supply, and have secured or scheduled transportation.
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They can improve patient throughput
Hospital discharge lounges, or DHCs, have been developed to improve patient throughput. They are intended to address the issue of patients occupying acute beds for several hours after their discharge while they wait for transportation or a meal.
At the Syracuse Veteran Affairs Medical Center, a DHC project was implemented to improve patient flow and discharge efficiency. This project was a success, with ED stays over 6 hours decreasing from 24.6% to 15.8%, discharges before noon increasing from 33.4% to 41.5%%, and the time from the discharge order being written to the patient leaving their inpatient bed improving from 126 to 84 minutes.
UAB Medicine also implemented a discharge lounge to reduce ED boarding times and improve patient care. The discharge lounge was designed to accommodate patients who had been discharged but were waiting for transportation home, freeing up hospital rooms to be cleaned and prepared for other patients. This initiative was successful in reducing average boarding hours.
While the evidence for the effectiveness of discharge lounges is limited, they are widely endorsed as a mechanism to accelerate access to inpatient beds and improve patient throughput. However, further rigorous investigation is required to determine the circumstances under which discharge lounges should be utilized and how they should be designed to maximize their impact on patient flow and ED boarding.
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Frequently asked questions
No, there is no evidence that discharge lounges have an impact on hospital readmission rates.
Discharge lounges are spaces where discharged patients wait to depart the hospital while completing the discharge process or awaiting transportation.
Discharge lounges help to improve patient throughput and flow by freeing up inpatient beds, reducing the time patients spend in the emergency department (ED), and decreasing the time between discharge orders and patients leaving the hospital.
Successful discharge lounges are designed through collaboration with stakeholders and address the challenges of previous implementations, such as lack of staff education, poor location, and inadequate patient screening.
