It’s no secret that shorter hospital stays are beneficial for patients. Research shows that a lower length of stay, measured from admission to discharge, correlates to an improved health outcome, lower risk of infection and reduced costs.
But the effects reach farther than the individual patient, as health care systems and patients across the country are finding. Unnecessarily long hospital stays can contribute to a host of dangerous, facility-wide throughput issues and hospital inefficiencies that ultimately affect the quality of care for patients at large.
A National Concern
One of these common problems is boarding, a capacity dilemma that occurs when newly admitted patients essentially become stuck in the emergency department (ED) after their initial care while waiting for an inpatient bed or a transfer, which increases multiple risks. Over the last couple of years, the American College of Emergency Physicians has identified this widespread issue as a national public health crisis and engaged in government advocacy efforts to find solutions. This fall, a national summit on boarding was held by the Agency for Healthcare Research and Quality in Washington, D.C.
In addition to causing crowding and longer wait times in the ED, a clogged patient flow cycle also backs up other hospital departments, such as the operating room, for example, as patients in the post-anesthesia care unit wait for available beds. The bottom line is this: the more that hospitals can reduce length of stay across the board, the better we can safely, efficiently and attentively care for all patients in our care.
Streamlined Discharge Offers a Powerful Solution
In light of this, our leadership at Riverside Health began exploring ways to specifically improve length of stay at our flagship hospital, Riverside Regional Medical Center (RRMC), in 2022. We found that delayed patient admissions were often caused by the occupation of beds by patients who no longer required clinical care but may still be arranging transportation, waiting on medication, finishing a meal or preparing to receive discharge instructions.
To address this, our team introduced Riverside’s first-ever discharge lounge, providing a comfortable, dedicated space for patients who are ready to go home, while freeing up rooms for patients who need clinical care. Its implementation has been dramatically successful, reducing RRMC’s average length of stay from 6.1 days in 2022 to 5.1 days in 2024.
Eliminating an entire day from the average length of stay so quickly is incredibly noteworthy, as many health systems strive for a quarter or half of a day. Equally impressive, this feat was accomplished in-house by our talented Riverside staff, rather than via the use of external consulting services.
A Distinctive Space Enables Concentrated Care, Accelerates Bed Turnover
To create the new discharge lounge, RRMC repurposed a second-floor space, transforming it into a spacious, bright, accommodating area that allows patients and nurses to specifically focus on the discharge process without interruptions. A secured location only accessible by badge, it consists of 25 comfortable chairs, including recliners, as well as small tables for personal items, a larger table for meals and charging stations for electronics so that patients can always communicate with their loved ones. Privacy screens enable quiet, one-on-one discussions regarding medical matters.
While waiting, patients and accompanying family members can find enjoyment or distraction in TV shows, magazines, books, crossword puzzles and coloring books, as well as snacks and beverages — hot cocoa is especially popular during colder weather. Patients are also able to exit the lounge and get a bite to eat from the hospital’s dining facilities if they wish.
Open Monday through Friday from 8:00 a.m. to 8:30 p.m., with the exception of holidays, our discharge lounge operating schedule is based on a data-driven decision to direct resources to the highest volume days and times. The lounge is staffed with a primary registered nurse (RN) who coordinates the discharge process and ensures closed-loop communication with all of the parties involved, like floor nurses, case managers, providers, the pharmacy and the durable medical equipment department.
Once she verifies that all criteria, such as the medication reconciliation and discharge summary, have been met, another RN serves as a runner who can go to the patient’s room to assist the floor nurse with clinical discharge tasks. Support is also provided by certified nursing assistants who can help move the process along by removing IVs, taking vital signs or getting patients dressed before they transfer to the lounge.
The discharge team can then take over any final steps, such as reviewing after-visit summaries and discharge instructions or having medical equipment delivered to patients, before accompanying them to the hospital’s front door when their transportation arrives. A script for all nurses involved is intended to clearly inform patients along the way, with a focus on making sure they have everything they need before departure.
Valuable Insights Gained
After an official launch in March 2023, our team had an opportunity to study and improve the process, relaunching with a fuller breadth of resources in March 2024. One step that made a significant difference was to shift the goal from capturing a numeric volume of patients to capturing an eligibility rate. After initially attempting to move as many people through the lounge as possible, which required continually checking on every discharge hospital wide, the team moved to a more fine-tuned approach.
The creation of a discharge lounge eligibility list within our iCare electronic health record system enabled easy identification of the appropriate population and a more efficient use of time and communication. Our current goal is to serve 65% of patients who are eligible to come to the lounge, with national standards around 60-65%. The team at Riverside has consistently met this goal, remaining steady around 65-70% and, at times, caring for as many as 85% of eligible patients.
Obtaining buy-in and feedback from nursing units by fostering a culture of teamwork, communication and recognition was also crucial to the success of this venture. When challenges arose during the learning process, dedication and problem-solving were key, as was the utilization of tools to quantify metrics so that they could be improved.
Domino-Effect Results are Evident
The discharge lounge has not only helped shoulder the load placed on our frontline bedside nurses, enabling them to meet pressing clinical needs, but it has also enabled an improved focus on discharge education, which sets our patients up for success, fosters safety and prevents readmissions.
Reception of the discharge lounge has been overwhelmingly positive. Patients and their families appreciate the beautiful space, often decorated for the season, as well as the attentive care, comfortable amenities and progress toward going home.
The lounge is currently discharging as many as 34 patients per day, surpassing initial goals. In addition to a drastically decreased average length of stay, Riverside Regional Medical Center has also seen a 33% reduction in ED boarders and a 40% decrease in patients who left without being seen. Discharges are occurring earlier in the day overall, and boarding time has decreased considerably, dropping from almost 11,000 boarding minutes in January 2024 to 2,000 in October.
There’s no question about it — the innovative discharge lounge model has absolutely transformed hospital efficiency and patient experience at Riverside and positively impacted the entire value stream.