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Discharge unit helps speed patient flow
ED goes more than 4 years without diversion
ED managers agree that overcrowding and gridlock, while often manifested most graphically in their department, are decidedly hospitalwide issues, and the experience of Sarasota (FL) Memorial Hospital seems to prove their point. For several years now, the hospital has run a "discharge unit," which houses patients who are ready to leave the facility while they wait for their transportation home to arrive. The unit is open from 8 a.m. until 7:30 p.m. Monday through Friday.
How has this unit affected the ED? "We have not been on divert since Dec. 1, 2004," says Lynne Grief, RN, PHD, director of emergency services. "We see about 80,000 patients a year, and for a department of our size, this is especially unusual."
The ED's overall flow situation is very smooth, Grief continues. "For example," she says, "last week we saw 83% of our patients in 30 minutes or less." During that same period, she adds, only nine patients left before treatment, which represented 0.6% of the department's volume. On an ongoing basis, she says, 75%-80% of the ED's patients are seen in 30 minutes or less, and 1%-2% leave before receiving treatment. "We know from research that the reason people walk back out is typically related to how long they have to wait," Grief notes.
Grief especially appreciates the unit because she has never worked in an ED before that had access to one. "Generally, if a hospital has a discharge unit, it means their philosophy is focused on patient throughput," she says. "It's one of the cogs in the wheel we have in place to make sure we get them upstairs in a timely manner."
The discharge unit "originated on the back of an ED doc's cocktail napkin," according to Janet Steves, RN, BSN, MBA, interim patient care director. The unit is located on first floor of the hospital, "directly near and visually connected to where patients drive up and also near the ED." It includes four private room areas, each with "a nice, full stretcher," where patients can continue their convalescence if need be. The other half of the unit is an open area with lounge chairs, a TV, and an entertainment center. The unit accepts discharged patients from inpatient units, the clinical decision unit, and the ED.
"We help the ED more by getting inpatients out of the hospital than by taking discharged patients from the ED," says Steves. "If the ED discharges patients and they are waiting for a ride, they can come to us, but a lot of them want to smoke and we are a nonsmoking campus, so their toleration for the unit is low."
There is one notable exception, however. "The ED has a clinical decision unit for observing patients," notes Steves. "Many times those folks, [once they are discharged] will use the discharge unit, too, if they need a ride and that ride will not be coming in a timely manner."
In other units in the hospital, Steves continues, patients are pulled from the floors as soon as they are ready to leave.