The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

Franklin, Brian J.; Vakili, Sharif; Huckman, Robert S.; Hosein, Sarah; Falk, Nicholas; Cheng, Katherine; Murray, Maria; Harris, Sheila; Morris, Charles A.; Goralnick, Eric

doi:10.1016/j.annemergmed.2019.12.002

Cited by 19 publications

(17 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our approach to avoiding boarder by expediting discharge after medical order is a pull forward strategy since the available bed will "pull" patients waiting for admission to the floor. Another process recently reviewed in the literature is a push-forward one, represented by the transfer of patients to a lounge on the floor, so the floor staff will try to guarantee an available bed [ 12 ]. This push-forward strategy still lacks definitive evidence of effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Decreasing boarders in the emergency department by reducing clerical work in the discharge process of in-hospital patients in Brazil – an interrupted time-series analysis

Moroço

Filho

2022

BMC Emerg Med

View full text Add to dashboard Cite

Background Emergency Department (ED) boarding is related to in-hospital patients' discharge since no beds will be available for receiving ED patients if there is a delay for patients in the yard leaving the hospital. New techniques implemented in hospital institutions, such as digital signatures to facilitate clerical work improve these processes. We evaluated the impact of expediting patients' discharge after medical orders with the number of patients with an unplanned hospital admission from the Hospital Out Clinic directed to ED for waiting for an available bed in a public tertiary hospital in Brazil. Methods We conducted a quasi-experimental study before and after an intervention. It consisted of an encrypted digital signature to reduce clerical work and expedite the patient's release from the institution after medical discharge. We used an interrupted time-series analysis based on administrative data (number of hospital discharges, bed turnover, the time between medical discharge, and the time the patient effectively left the hospital) from 2011 to 2020. Results We enrolled 210,496 patients admitted to the hospital from January 2011 to December 2020. Of those, 69,897(33%) composed the group after the intervention. There was no difference between the groups' gender, age distribution, the proportion of surgical patients, or in-hospital stay (≤ 7 or > 7 days). The interrupted time series analysis for the time from medical order to effectively hospital discharge showed an immediate change in level (Coefficient β2 -3.6 h—95% confidence interval -3.9;-3.4), but no a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient—95% confidence interval -0.0040;0.0050). For the number of patients directed to ED, we observed no immediate change in level (Coefficient β2 -0.84 patients—95% confidence interval -0.33;0.16), but a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient—95% confidence interval -0.0040;0.0050). Conclusion Reducing clerical work and expediting patient discharge was associated with decreased potential boarders to ED.

show abstract

Section: Discussionmentioning

confidence: 99%

Decreasing boarders in the emergency department by reducing clerical work in the discharge process of in-hospital patients in Brazil – an interrupted time-series analysis

Moroço

Filho

2022

BMC Emerg Med

View full text Add to dashboard Cite

show abstract

“…Our approach to avoiding boarder by expediting discharge after medical order is a pull forward strategy since the available bed will "pull" waiting for patients to the oor. Another process recently reviewed in the literature is a push-forward one, represented by the transfer of patients to a lounge on the oor, so the oor staff will try to guarantee an available bed [12]. This push-forward strategy still lacks de nitive evidence of effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Boarders in the Emergency Department By Reducing Clerical Work in the Discharge Process of In-Hospital Patients – An Interrupted Time-Series Analysis

Moroço

Pazin‐Filho

2021

Preprint

View full text Add to dashboard Cite

Background: Emergency Department (ED) boarding is related to in-hospital patients' discharge. New techniques implemented in hospital institutions, such as digital signature, offer an improvement on these processes.Goals: Evaluate the impact of expediting patient's discharge after medical orders with the number of patients diverted to ED.Methods: We conducted a quasi-experimental study before and after an intervention. It consisted of an encrypted digital signature used to reduce clerical work and expedite the patient's release from the institution after medical discharge. We used Interrupted Time Series Analysis based on administrative data (number of hospital discharge, bed turnover, the time between medical discharge and the appointment's closing) from 2011 to 2019 using.Results: The interrupted time series analysis for the time from medical order to virtually hospital discharge showed an immediate change in level (Coefficient β2 -3.6 hours - 95% confidence interval -3.9; -3.4 - Lag1), but not a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient - 95% confidence interval -0.0040; 0.0050 - Lag1). For the number of diverged patients to ED, we observed no immediate change in level (Coefficient β2 -0.84 patients - 95% confidence interval -0.33; 0.16 - Lag1), but a difference in the slope of the behavior of the post-intervention curve (β3 0.0005 coefficient - 95% confidence interval -0.0040; 0.0050 - Lag1).Conclusion: Reducing clerical work and so expediting patient discharge was associated with a decrease of potential boarders to ED.

show abstract

“…5 A common focus of departure lounges has been patients who have completed discharge paperwork and are waiting for transportation. 6 Health centers that utilize a departure lounge establish criteria to determine eligible patients. 7 Key components to a successful departure lounge include communication with stakeholders and their buy-in to the selection of appropriate patients and a convenient location facilitating patient pick-up.…”

Section: Departure Loungesmentioning

confidence: 99%

“…In many facilities, a departure lounge has benefited in earlier discharges as well as decompressing EDs 5 . A common focus of departure lounges has been patients who have completed discharge paperwork and are waiting for transportation 6 . Health centers that utilize a departure lounge establish criteria to determine eligible patients 7 .…”

Section: Departure Loungesmentioning

confidence: 99%

Implementing a Departure Lounge

Barone

Miller

Long

et al. 2022

JONA: The Journal of Nursing Administration

View full text Add to dashboard Cite

show abstract

The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

Cited by 19 publications

References 14 publications

Decreasing boarders in the emergency department by reducing clerical work in the discharge process of in-hospital patients in Brazil – an interrupted time-series analysis

Decreasing boarders in the emergency department by reducing clerical work in the discharge process of in-hospital patients in Brazil – an interrupted time-series analysis

Decreasing Boarders in the Emergency Department By Reducing Clerical Work in the Discharge Process of In-Hospital Patients – An Interrupted Time-Series Analysis

Implementing a Departure Lounge

Contact Info

Product

Resources

About