In a follow-up to last week’s article about when discharge lounges do not work, I thought I would elaborate today on when the concept can provide efficient relief for capacity issues.
Although the focus has historically been on the back-end process, moving patients out of their hospital rooms to alleviate congestion at the front, there is evidence supporting their effectiveness when discharge lounges assist not only hospital units, but also emergency departments (ED), and operate by a “pull” system rather than a “push” system.
ED overcrowding remains a significant challenge for hospitals across the country, leading to prolonged patient wait times, decreased patient satisfaction, and increased strain on medical staff. Implementing discharge lounges for patients who are stabilized but need to wrap up the logistics of returning home has proven effective in enhancing patient flow and alleviating ED congestion.
In a “push” system, hospital units or ED staff send patients to the discharge lounge when they deem them ready, based on a long list of eligibility criteria. This can lead to inefficiencies and underutilization. In contrast, a “pull” system actively identifies and relocates patients who meet discharge criteria, optimizing patient movement and improving throughput.
Hospitals that have successfully implemented a pull system employ dedicated discharge teams that proactively seek out patients eligible for discharge, ensuring a steady flow of patients to the lounge. These teams coordinate with unit nurses, physicians, and case managers to identify and transition patients efficiently. This approach prevents bottlenecks in the ED and bedded units, ensuring that beds are available for incoming patients who require immediate care.
Montefiore Health System implemented a discharge lounge that serves approximately 678 patients per month, or about 22 patients per day. Montefiore reports that their discharge lounge is six times more effective than other lounges, largely due to its role in serving both hospital units and the emergency department. Their system moves patients efficiently by proactively pulling them from bedded units and the ED, rather than waiting for units to push patients to the lounge (Montefiore, 2024).
The University of Alabama at Birmingham (UAB) Hospital has also refined its discharge lounge operations over time. Initially, it accommodated only four patients a day, but by 2022, it averaged 20 patients daily. The key to this improvement was a dedicated discharge team that actively pulled patients from the units, ensuring a smooth transition to the lounge and reducing overall hospital congestion.
Repurposing discharge lounges to support ED throughput and create a better environment for patients who have completed their ED evaluation, but require additional logistics such as obtaining medications, follow-up referrals, education, support appointments, or coordinating transportation can significantly alleviate ED congestion. A pull system ensures that discharge-ready patients are efficiently relocated, freeing up critical ED and inpatient resources. By focusing on active patient identification and proactive support to facilitate the discharge process, hospitals can optimize resource utilization, improve patient experiences, and enhance overall operational efficiency.
References
Montefiore Einstein (2024). Montefiore Discharge Lounge Offers Stress- Free Transition from Hospital to Home While Saving 10,000+ Bed Hours. Retrieved from Montefiore Discharge Lounge Offers Stress-Free Transition from Hospital to Home While Saving 10,000+ Bed Hours | Update | Montefiore Einstein Now
UAB Medicine News (2022) Nursing leaders created patient discharge lounge to reduce ED boarding time. Retrieved from Nursing leaders create patient discharge lounge to reduce ED boarding time
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