Improve patient throughput and capacity management.
- Delays in patient discharge frequently result in decreased inpatient bed availability, increased emergency department patient holds, and increased length of stay.
- Discharge lounges have been reported as a potential solution for improved patient throughput, optimization of hospital resource utilization, and prevention of operational congestion in emergency departments.
- The literature is limited on the impact of discharge lounges in hospitals on the structure, patient eligibility, and qualifications of the staff working in the area.
Patient throughput from the emergency department (ED) to time of discharge remains a national priority across healthcare systems. Efficient patient flow helps to ensure timely care, reduces overcrowding, and improves overall patient satisfaction. However, several challenges can impede this process, including prolonged wait times in the ED, delays in diagnostic testing and treatment, and bottlenecks in transferring patients to appropriate units.
In some cases, prolonged ED wait times result in patients leaving without seeing a provider, which poses a safety risk, increases the chances that the patient will return to the ED within 30 days, and raises readmission rates. The discharge process itself can prove complex, frequently involving coordination among multiple departments and ensuring that patients have the necessary follow-up care and resources. Addressing these issues requires a comprehensive approach that includes optimizing ED operations, streamlining communication and coordination among healthcare providers, and implementing effective discharge planning strategies.
Discharge planning assessment tool
Executing a dedicated discharge lounge in the hospital setting can provide a comfortable and safe space for patients who’ve received medical clearance for discharge with few care needs remaining, such as administering final doses of I.V. medications, coordinating transportation, and obtaining durable medical equipment or prescriptions. Research indicates that discharge lounges help free up valuable ED and inpatient beds more quickly, optimize patient flow, enhance the efficiency of healthcare delivery, and improve the patient experience from admission to discharge.
The situation
AdventHealth Daytona Beach, a 362-bed hospital, uses the National Emergency Department Overcrowding Score (NEDOCS) to monitor its ED’s crowding level. NEDOCS has five categories: green (normal-level crowding), yellow (busy), orange (overcrowded), red (severe crowding), and black (disaster-level overcrowding).
The hospital’s nursing leadership and executive team discussed the need for a solution to improve patient throughput and capacity management as the average daily NEDOCS identified the facility as level red or black 44.8% of the time with an average daily headcount of 405 from January to June 2023. Leadership determined that having a dedicated space for patients ready for discharge could help improve patient throughput by providing earlier bed availability to patients being held in the ED. The executive director of clinical operations led the discharge lounge pilot team, which included an RN administrative supervisor, lead RN discharge expeditor, two LPN discharge specialists, and two patient care technicians.
Literature review
Since the 1990s, hospitals have implemented discharge lounges to counteract the many hours between the time a provider places a discharge order to the time a patient departs their room. Eligible patients move to the lounges, located in a designated area, where they receive discharge instructions while awaiting arrangements for transportation.
Some of the research analyzing the impact of discharge lounges on patient experience shows an accelerated pace of patient transition, resulting in diminished communication among staff, patients, and caregivers. A descriptive, retrospective study by Emmerling and colleagues analyzing the effects of a discharge lounge on 30-day hospital readmission found no significant difference in the readmission rate based on discharge location. A study by Woods and colleagues, investigating patients’ and caregivers’ experiences of being transitioned to a discharge lounge, identified that patients and caregivers felt “removed” and that the facility was “moving the problem.”
The literature remains limited on this topic and notes that no standardized discharge lounge process exists, including how to determine patient eligibility and staff qualifications. The literature notes variability of discharge lounge effectiveness at reducing ED overcrowding and improving patient throughput (earlier patient discharge times, decreased length of stay, and reduced ED left without being seen [LWBS] metrics).
Discharge lounge and departure process
A pilot of the discharge lounge at AdventHealth Daytona Beach occurred from July 2023 to September 2024. Before implementation, nursing staff on inpatient units received education about determining patient eligibility and what types of care could continue in the discharge lounge.
The lounge, located on the first floor of the hospital, included four beds, each in their own full care-capable rooms, and eight recliners with equipment to meet all patient needs and comfort measures. The lounge operated Monday through Friday from 8:00 am to 8:30 pm.
Staff included an RN administrative supervisor to serve as the throughput coordinator (who identified patients eligible to move to the discharge lounge), a lead RN discharge expeditor (who attended daily multidisciplinary rounds among inpatient units to identify additional patients), two LPN discharge specialists (who provided care and ensured arrangements for durable medical equipment and transportation), and two patient care technicians. The LPN discharge specialists also delivered discharge information, including specialized education and resources for patient populations at risk for readmission, such as those with heart failure, acute myocardial infarction, or a coronary artery bypass graft (CABG). The patient care technicians transported patients from the inpatient areas to the discharge lounge and assisted with activities of daily living within the lounge.
Patient eligibility
A patient’s level of discharge readiness, determined during daily multidisciplinary rounds, established their eligibility for the lounge. These physician-led, interdisciplinary meetings with members of the patient’s care team included the assigned nurse, the case manager, and the unit nurse leader who reviewed discharge orders and assigned the discharge readiness level. The primary nurse, case manager, and RN discharge expeditor then assessed the patient’s level (coded as green, yellow, or red), with the assistance of the throughput coordinator, to determine which patients met eligibility for transfer to the lounge.
The team prioritized patients identified as green because they had discharge orders in place with no additional barriers to leaving the facility. Patients designated as yellow had only a few barriers noted, such as a final dose of I.V. antibiotic, peripherally inserted central catheter placement, or diagnostic imaging; all of these tasks could be completed from the discharge lounge. Patients identified as red were transitioned last as they had higher barriers to discharge, such as long-term care transportation pick-up arrangements scheduled for later in the evening. The team excluded all patients with infectious airborne precautions.
Full implementation
In October 2024, the hospital fully implemented the discharge lounge. Virtual beds integrated into the electronic health record allowed for removal of patients from their unit beds and assignment to discharge lounge beds, while keeping patient quality and satisfaction data assigned to the original inpatient unit.
At full implementation of the lounge, eligibility and exclusion criteria remained the same, demonstrated by patient level of discharge readiness, with the addition of supplemental patient and family accommodations that included the opportunity to watch television, play board games, and order room service. The lounge serves as a comfortable, safe space for patients and families to await final discharge and also improves the hospital’s capacity management and patient throughput.
Outcomes
The discharge lounge pilot team measured successful implementation of the discharge lounge by comparing quarterly data from January 2023 to December 2024, including patient discharge times, ED admit door to departure, LWBS metrics, and patient satisfaction. The percentage of patients discharged before 11:00 am and 2:00 pm increased from 2% to 11% and 19% to 43%, respectively. LWBS decreased from 2.2% to 0.6%, and ED admit door-to-departure times decreased from 843 minutes to 519 minutes.
With regard to patient satisfaction, survey results from the Hospital Consumer Assessment of Healthcare Providers and Systems showed that patients reported an increase in the discharge information they received (from 86.27% to 88.63%) and positive care transitions domain (from 52.37% to 55.2%). In addition, transitioning patients to the discharge lounge resulted in an 11% increase in daily requests for room turnover before 3:00 pm and an average 90-minute earlier bed availability for admitted patients being held in the ED.
The NEDOCS level of overcrowding reduced from a daily average code red or black status of 44.8% to 14.56%, both with an average daily headcount around 400. This represents an improvement in capacity management with a similar daily headcount and a significantly lower NEDOCS.
The evaluation of readmission rates indicated the effectiveness of the specialized discharge education provided to patients at high-risk. Readmission rates for patients with CABG decreased from 15.63% to 9.52%; for patients who’d experience an acute myocardial infarction, rates decreased from 13.87% to 11.59%; and for those with heart failure, readmission rates decreased from 21.57% to 19.91%.
Knowledge gained and next steps
At the initial launch of the discharge lounge, many inpatient nurses expressed hesitation about sending their patients. They felt as if they were relinquishing patient care before discharge and voiced responsibility for uncompleted tasks or education. The pilot team addressed all barriers after the full implementation of the discharge lounge and provided ongoing staff education to support the new workflow and ensure clear understanding of expectations regarding the LPN discharge specialists.
The demonstrated success of the discharge lounge has triggered processes to acquire specialty-based RN discharge navigators, including those in the cardiovascular, neurologic, and surgical service lines to care for special patient populations transferred to the discharge lounge. These patients will receive care packages specific to their needs, such as clinically required items for heart failure patients, which include weight-scale records for home documentation. Discharge lounge staff will make follow-up phone calls to patients, with more frequent calls to those at high-risk for readmission.
Positive impact
The implementation of this discharge lounge differs from the cases published in the available literature due to the comprehensive patient care and discharge education provided in the lounge. Completing this care in the lounge allows for earlier bed availability to admitted patients waiting in the ED.
Factors unique to individual hospitals—such as bed size, staffing, lounge design, and workflow—can determine the success of a discharge lounge and create barriers to generalizing outcomes. Further research and quality initiatives will help to identify the appropriate design, workflow, and patient eligibility to positively impact capacity management and patient throughput.
Kristine Gromlovits is director of professional development and clinical excellence at AdventHealth in Daytona Beach, Florida.
References
Barone M, Miller J, Long MS, et al. Implementing a departure lounge: A strategy to improve patient flow and the discharge process. J Nurs Adm. 2022;52(3):129-31. doi:10.1097/NNA.0000000000001118
Emmerling SA, Fisher MC, McGarvey J. The use of a patient discharge lounge and the impact on 30-day hospital readmission. J Nurs Adm. 2020;50(11):590-7. doi:10.1097/NNA.0000000000000942
Franklin BJ, Vakili S, Huckman RS, et al. The inpatient discharge lounge as a potential mechanism to mitigate emergency department boarding and crowding. Ann Emerg Med. 2020;75(6):704-4. doi:10.1016/j.annemergmed.2019.12.002
Lees-Deutsch L, Gough B, Yorke J, Caress AL. Patient and caregiver experience of hospital discharge from an acute medicine unit via the discharge lounge: A qualitative case study. Acute Med. 2020;19(1):26-33.
Smalley CM, Meldon SW, Simon EL, Muir MR, Delgado F, Fertel BS. Emergency department patients who leave before treatment is complete. West J Emerg Med. 2021;22(2):148-55. doi:10.5811/westjem.2020.11.48427
Woods R, Sandoval R, Vermillion G, et al. The discharge lounge: A patient flow process solution. J Nurs Care Qual. 2020;35(3):240-4. doi:10.1097/NCQ
American Nurse Journal. 2025; 20(9). Doi: 10.51256/ANJ092554
