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.
Sources
For more information on the benefits of discharge units, contact:
- Lynne Grief, RN, PHD, Director of Emergency Services, Sarasota (FL) Memorial Hospital. Phone: (941) 917-8502.
- Janet Steves, RN, BSN, MBA, Interim Patient Care Director, Sarasota Memorial Hospital. Phone: (941) 917-7378.
Unit can be created with small investment
The ED at Sarasota (FL) Memorial Hospital has not gone on diversion since Dec. 1, 2004, and one of the key reasons is the hospital's discharge unit, which allows staff to free up beds on the floors by giving discharged patients a place to wait for their rides home. Despite its obvious value, Janet Steves, RN, BSN, MBA, interim patient care director, says such a unit does not necessarily require a large investment of resources.
"That's the big secret to our success," says Steves, who adds that basically 80% of all discharging patients are using the unit. The hospital will discharge 100 patients on a typical day. "We have two FTEs. One is an RN, which you must have to be successful," she says. "If the vast majority of these patients come from the floors, none of the [floor] nurses who have cared for them so beautifully will want to send them down to a holding area with no one qualified to take care of them."
The other employee, called a health unit coordinator, is "basically a secretary," says Steves. This individual and the nurse facilitate the collection of patients, because central transport does not pick them up. "We have a computerized bed tracking system, and they monitor it to see when patients are ready to be discharged," she explains. "Then they dispatch the volunteers to the appropriate location, and they bring the patients down in a wheelchair, which is their primary responsibility."
Steves has a team of 30 volunteers, "and hence it costs you very, very little to run the unit."
Make a strong case for discharge unit
If your hospital does not have a discharge unit, you should be able to make a strong case for adding one, argues Lynne Grief, RN, PHD, director of emergency services at Sarasota (FL) Memorial Hospital, which has had such a unit for several years.
"Every ED in the country has 'boarders,'" she notes. This unit is an inexpensive way to alleviate your backlog, she says. "For example, you're not building more ED beds, which are very expensive, and you're not adding whole floors of beds to the hospital," Grief says.
In addition, she notes, a discharge unit is a "patient pleaser." That's especially true in Sarasota, says Grief, where there are many elderly patients. "The family does not feel pressured to have to go pick them up immediately because they are watched over by a nurse," she says. "Plus, they are very comfortable; it's like a living room with recliners."
As for the financial return from Sarasota Memorial's discharge unit, "if it did not pay for itself, it would not be kept in the budget," says Grief. If an ED manager wanted to see one created at their facility, she says, "I bet they could make a financial case."
Point out that if you can empty beds in the ED, you will reduce your length of stay, Grief says. "If you can empty beds in the ED, your walkout rate drops as well," she adds. "It's much safer for patients to be in the back and not in the waiting room, so the hospital's potential exposure to liability is also reduced."
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.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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