6 discharge lounge best practices
More hospitals and health systems are leaning on discharge lounges to decongest EDs and improve patient experience, but there are no industrywide procedures for setting up a lounge.
The first lounges were piloted around 2020 and have gained popularity over the last few years. Palos Heights, Ill.-based Northwestern Medicine Palos Hospital opened its discharge lounge in December 2022. Within a year, the lounge cut average ED wait times down to one hour, cut the number of patients left without being seen by 49% and improved both inpatient and ED patient experience scores.
Becker’s spoke with Rebecca Baute, BSN, RN, chief nurse executive, and Brittany Barasa, DNP, RN, manager of patient care of nursing throughput and patient care tech float pool, in an upcoming Becker’s Healthcare “Clinical Leadership Podcast” to discuss the best practices for setting up a successful discharge lounge.
Here are the six best practices they recommend:
1. Having the right staff run the lounge is critical, Ms. Baute said. Their lounge is run by a dedicated, tenured registered nurse who can work independently and has strong critical thinking skills, along with a patient care technician. These staff are prepared to recognize when a patient decompensates and needs to be readmitted, and can review charts, identify potential discharges proactively and understand where bottlenecks are likely to occur.
2. Setting clear expectations and having an in-depth orientation ensures the discharge staff can work independently from day 1. Discharge staff participate in the same annual skills days as the hospital’s med-surg and step-down nurses to ensure they have the same training and exposure to products and tools, Ms. Barasa said. Leaders also connected discharge staff with the physical therapy team to train them in body mechanics, so that staff could better help patients go from stretchers or wheelchairs into cars. This prevents injury for the discharge staff and provides a safer environment for patients.
3. Discharge lounges should be close to an exit where ambulance partners and families can pull right up and have a direct path to patients. That ease of access makes a real difference, Ms. Baute said. At the same time, having proximity to clinical support means the discharge staff is surrounded by other nurses who can respond quickly if a patient’s condition worsens.
4. Patient comfort is also vital, since some patients spend hours in the lounge. The hospital provides quiet packs that include earplugs, eye masks, crossword puzzles and other items to keep patients comfortable and entertained. The lounge also has access to a restroom, and space for medical supplies and equipment.
5. The lounge is open Monday through Friday from 9 a.m. to 5:30 p.m. At the beginning of each day, the team reviews all patients with current discharge orders and uses a team chat that includes discharge lounge staff, charge nurses and relief charge nurses, to identify patients that are ready to be sent to the lounge. Patients are transferred to the lounge, where they then receive education, the after-visit summary, medication and are discharged. During slow periods, the lounge staff rounds on units proactively to assist with discharge and bringing patients to the lounge.
6. Communication across the organization is key. “Interdisciplinary teams need to understand the why behind the discharge lounge,” Ms. Baute said. “Much of the time, the purpose is to decompress the emergency department, and a surprising number of people across the organization don’t realize that we may have 40 patients holding in hallways. Without that shared understanding, teams won’t consistently use the lounge as the resource it’s meant to be.”
Communication also includes constantly reviewing and expanding the patient criteria over time to meet the current needs or the organization.
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