Discharge Areas/Lounges

[chelsea554]

Hello-

Do any of your emergency departments have a dedicated discharge area? We are looking to implement an area that we can move patients to be discharged, therefore opening up a patient room and also not rushing the patient through the discharge process. This will allow a nurse to get vitals, answer questions, and ensure all charting is completed without feeling rushed to get a new patient into the room.

If you have an area similiar to this, could you please answer the following questions:

1. Would you be willing to share your discharge policy/procedure/guideline?

2. What hours do you utilize this area? 24/7 or just during peak hours?

3. What is your daily or yearly patient volume?

I am sure I will have more questions, but can't think of any at this time! Thank-you!

[skylark, BSN, RN]

Its now standard in the UK, thanks to the government's wonderful 4 hour limit on every patient in the ER!

So yes, there is a designated area, and usually at least one RN maybe a CNA as well.

They are primarily 'baby-sitting' the patients, (sorry, just can't think of a better word), and get involved in the practical details such as receiving meds to take home, co-ordinating transport services, making sure caregivers know they are coming home, ensuring keys or some sort of access when they get home . . . . .

Most ER nurses detest it as its not what we are trained to do.

But as long as your manager is careful to rotate nurses there, so you maybe do one day every two weeks or so, then its ok, and a chance to actually sit and talk with your patients!!

I think that most are open 7a to 7p, every day, but there will be variations on that.

I'm in the US right now but also work registry in London, England, and I think our department in London sees around 130,000 patients a year.

Discharge lounge occupants tend to be the elderly living alone, waiting for care services to be established before they can leave.

Rarely its someone there for a clinical reason, maybe had a shoulder reduction and has taken longer that the permitted 4 hours to recover from sedation.

But most are just waiting for services, transport, prescriptions, etc.

[That Guy, BSN, RN, EMT-B]

We have a brand new ER with one of these rooms....that is stuffed with crap since we dont staff it right.

[turnforthenurse, MSN, NP]

We only utilize a discharge room in our Fast Track area that is only open until 2300. After the patient has been treated they are moved to the discharge room where the nurse (or tech) obtains their VS and goes over their d/c instructions. We are looking at implementing a discharge room or even a "results pending" area in our main ER.

My question, though (for a "results pending" area), is how many patients do you put in a room together? Is there just 1 RN assigned to that area to administer additional medications if needed? For a discharge room, what if there is something abnormal in the vital signs that warrant further intervention? For example, the patient's BP ends up being a little low, you notify the provider and they decide they want to give the patient a bolus of fluids prior to d/c. You just gave up their ER bed and now they are in the discharge room but that will mess up the flow in regards to discharging patients.

I'm just trying to look at barriers and solutions and how y'all do things in your ER. We're trying to increase our patient satisfaction and decrease our wait times which includes door to provider exam and door to dispo/discharge.

[OlivetheRN, ADN, BSN, RN]

My question, though (for a "results pending" area), is how many patients do you put in a room together? Is there just 1 RN assigned to that area to administer additional medications if needed? For a discharge room, what if there is something abnormal in the vital signs that warrant further intervention? For example, the patient's BP ends up being a little low, you notify the provider and they decide they want to give the patient a bolus of fluids prior to d/c. You just gave up their ER bed and now they are in the discharge room but that will mess up the flow in regards to discharging patients.

I'm just trying to look at barriers and solutions and how y'all do things in your ER. We're trying to increase our patient satisfaction and decrease our wait times which includes door to provider exam and door to dispo/discharge.

We have a CDU that we open to use to hold admitted pt's who are waiting on a bed on the occasions that the floors are full, and when it's open we can also use it to hold pts who are waiting on repeat troponin results or other results. We've never used it as an area to hold pt's who are just waiting to be d/c. For the pt's who are waiting results, if they need further intervention the rooms are stocked like our ER rooms, with exception of monitors in every room. We use portable monitors and also have tele boxes we use for the admitted tele pts. We generally will staff it with 1-2 nurses for the ten bed unit, and most of the time they're floor nurses that are called in if we're holding admitted pts, but at times if we have the numbers it will be staffed with one of our own nurses and hopefully a tech or a CNA.

I'm not sure if that helps at all since it's not a unit we have open 24/7 or even every day, but I thought I'd throw the info out there :)