Optimizing Utilization of the Discharge Lounge with Technology

Background: Timely inpatient hospital bed availability is an essential component to improving patient throughput. To improve patient flow at a large academic medical center and address capacity challenges, the discharge lounge (DCL) was implemented. The DCL provides a safe alternative space for patients to await transition to their final discharge destination once their medical and nursing care have been completed. The main purpose of establishing a DCL is to increase availability of inpatient beds, thereby expediting patient flow. Despite multiple attempts, the DCL experienced low utilization. The gap in the current DCL process was the labor-intensive identification of patients eligible for the DCL as well as the tracking of its usage. Technology is a potential solution to this problem.

Purpose: The purpose of this poster presentation is to describe the workflow design for optimizing healthcare technology by developing an electronic DCL patient identification tool, evaluate its impact on the volume of eligible patients, and share the improvements seen in the DCL utilization rate.

Design and implementation: DCL RNs discussed and defined the eligibility and exclusion criteria. Informatics analysts then mapped these criteria to existing EHR data points and build analysts developed logic to display patients who met all the criteria. Report writers created a real-time dashboard to notify DCL RNs and provide transparency to inpatient staff. Retrospective reports were also created to measure utilization trends. A DCL workgroup evaluated the effectiveness of this innovation by tracking the monthly volume of eligible patients, volume of patients sent to the lounge, and the utilization rate (UR).

Results/impact: Prior to the implementation of the DCL tool to assist with the identification of eligible patients, the DCL saw an average of 85 patients per month (January to September 2022) with an average UR of 27%. After the implementation of the DCL tool, the DCL saw an immediate increase in the daily volume of patients sent to the lounge, and a second RN was added to the DCL in late October. From October 2022 to March 2023, the DCL saw an average 331 patients per month (289% improvement) with an average UR of 58%. In April 2023, the DCL increased their operational hours to include the weekends. The average monthly volume from April to October 2023 was 999 patients per month with an average UR of 77% during that time.

Conclusions: The new build has been an important mechanism to expedite the identification of DCL appropriate patients. Although an increase in the UR and volume of patients sent to the lounge was noted in the months after its implementation, further refinement of the tool is needed to capture other patient populations. Observation patients and procedural patients are currently not identified by the electronic tool; a future next step is to improve the tool to identify these patients. In order to help staff understand patient flow and prioritize early discharges, recognition of the demand for beds due to the real-time hospital census and the need for bed availability is crucial.