Discharge Waiting Room Gives Patients a Comfortable Place Between Bed and Home
A health system’s nurse case manager oversees a discharge waiting lobby that has helped shorten the time to discharge patients and frees beds for patients waiting in the ED.
The discharge waiting lobby helps ease transitions during a difficult time for hospitals. Many hospitals experienced long waits for beds during COVID-19 pandemic surges. Staffing shortages are continuing even as the pandemic ebbs.
“Having this discharge waiting lobby is going to be important because we continue to struggle with capacity issues,” says Amanda Hargrove, DNP, NE-BC, CMAC, ACM-RN, administrator in case management and utilization management for Vidant Health in Greenville, NC. “On any given day, we have 25 to 30 patients in the ED who are admitted but waiting for beds on the unit, so it’s important for us to all work together so we can discharge patients as efficiently and safe as possible. This is one way to discharge promptly from the unit and get patients down to the discharge waiting room.”
Since beginning the program, the 900-bed hospital’s discharge order time to actual discharge was shortened from more than three hours to two hours and 20 minutes, according to internal data.
“The waiting lobby holds 15 patients,” Hargrove explains. “When patients are discharged from the floor, they come to the waiting lobby. That allows us to open the unit and get people to their room faster.”
This is how the discharge process solution works:
• Establish patient criteria for the lobby. Patients who are sent to the discharge waiting lobby have to meet specific criteria:
- They must be adults, age 18 years or older;
- They must be independent and able to perform activities of daily living, such as going to the restroom independently;
- They should not need additional medication, including insulin or pain medication, during the wait;
- They can be on low-liter oxygen;
- They must be ready for discharge.
“We use that information in [our electronic medical record] as a tool to identify those patients,” Hargrove says. “Our IS [information systems] team built that into [our EMR] for us to identify those patients.”
The discharge waiting lobby is used by many patients, including patients from medical units, trauma units, and observation units.
“We’ve even had patients use it from the ED, where they were discharged and their wait is a little longer, so they wait in our lobby for their ride,” Hargrove says.
• Use available, private space. “We have a closed lobby with doors,” Hargrove says. “Prior to our acquiring the space, it was the surgical waiting room, which has moved to another space.”
The discharge waiting lobby is close to the main entrance, making it easier to bring patients out to families waiting in cars near the entrance.
“They call the discharge lobby, and we get volunteer services to wheel them out,” Hargrove explains.
The dedicated space offers comfortable chairs, including some recliners. Patients can watch TV while waiting. They also receive a fresh boxed meal. Snacks and beverages are available in a small refrigerator.
“The box meal has a sandwich and fruit,” Hargrove says. “Patients don’t have to wait for a meal.”
There is a separate area for patients with positive COVID-19 tests where they can be quarantined confidentially.
“The lobby is open until six in the evening. If their ride falls through, we can get them a taxi,” Hargrove says.
• Employ a dedicated nurse case manager. The nurse case manager can handle the discharge process and paperwork, and make patients feel safe and comfortable as they wait to leave the hospital.
Volunteer services brings patients from the hospital floor to the lobby because the case manager stays in the waiting area.
“The case manager works closely with the charge nurses on the floor, identifying people who meet the criteria,” Hargrove says. “They discuss those patients in progress care rounds.”
• Provide discharge medication and equipment. “We have our outpatient pharmacy deliver medications to patients in the lobby before they leave,” Hargrove says. “We collaborated with DME [durable medical equipment] companies in the area who deliver walkers, oxygen, and other things.”
DME providers deliver patients’ medical equipment to the discharge waiting lobby. “It’s easy for them to drop it off there and speak with the patient in an area where there can be confidentiality,” Hargrove says.
Pharmacy staff also deliver medication to the discharge lobby and review the regimen with the patient in the confidential area.
• Help lobby evolve. “There are still opportunities to improve it, and that’s what we’re working on,” Hargrove says. “We’re trying to be innovative and work with different things in our hospital and with post-acute providers to improve efficiency and maintain our quality of care.”
When the hospital opened the discharge lobby in December 2020, there was not yet collaboration with the pharmacy and DME providers. The EMR also did not include the criteria tool.
“We’re always looking for ways to improve it,” Hargrove says. “Recently, we implemented a change where the discharge waiting room case manager is going to help the bedside nurse do patient education and print the discharge summary.”
This helps take some of the discharge process off the bedside nurse and moves it to the discharge lobby. “We cross-trained the case manager so she can help out on weekends with the inpatient team, as needed,” she says. “She can help get patients a taxi, can help with the DME, or help with any last-minute need.”
Patients and their families have given positive feedback. “Our nurse case manager is wonderful and loves to interact with the patient, making it very comfortable for them,” Hargrove adds. “Families don’t have to park their cars. They can just drive through the pickup line and wait for the patient to come out. It’s quick, easy, and efficient.”
The discharge lobby is a valuable resource as hospitals struggle with nursing shortages. “The pandemic has affected all nursing and healthcare,” Hargrove says. “Nursing is critical.”
A health system’s nurse case manager oversees a discharge waiting lobby that has helped shorten the time to discharge patients and frees beds for patients waiting in the ED. The discharge waiting lobby helps ease transitions during a difficult time for hospitals.
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