Discharge Lounges: An Innovative Way to Reduce ED Overcrowding

Emergency department (ED) overcrowding is a long-standing problem in many parts of the country. Not only can ED overcrowding contribute to patient dissatisfaction due to long wait times, it can also create patient safety concerns resulting from delayed evaluation and treatment. 

Many of the patients occupying ED bed space are “boarders.” Boarding is the practice of caring for patients in the ED after their admission to the hospital. ED boarding often occurs due to a lack of available patient beds—beds that are often needlessly occupied by patients who are medically cleared for discharge but waiting for a ride home or to complete discharge paperwork. ED boarding is associated with poor outcomes in critically ill patients and can increase the incidence of delirium in older patients.

To ease ED overcrowding, some organizations have created discharge lounges—a designated hospital area where patients can wait until their discharge is complete. An innovative idea designed to free up bed space and streamline the discharge process, discharge lounges are gaining traction in U.S. hospitals and around the world. Some organizations that have implemented a discharge lounge program have drastically reduced ED boarding times and significantly reduced the percentage of patients who leave the ED without being seen. What’s more, their patient satisfaction scores from inpatient units and the ED have improved. 

While discharge lounges seem like a good solution for ED overcrowding, they can also increase risk. Discharge lounges with inappropriate patient admission policies, poor supervision, or inefficient workflows can stop being cost-effective and start exposing an organization to liability. 

Risk Recommendations

Discharge lounge programs can be an innovative way to accelerate access to inpatient beds and boost patient satisfaction. To minimize risk, however, it is imperative to implement the program only after sufficient planning and in the context of well-designed policies and procedures. Consider the following when designing and implementing a discharge lounge program at your organization: 

Designate a space. Locate discharge lounges close enough to patient care areas to facilitate patient observation. Designate a location near restrooms and public entrances so family members can easily locate and transport the patient on arrival.

Develop policies and procedures. Ensure that policies and procedures for discharge lounges address the following:

• Patient selection. Work with an interdisciplinary team to determine patient eligibility guidelines. Specify that only patients who can care for themselves and do not have physical or mental issues requiring supervision are eligible for discharge lounge admission. Patients who are at risk of falls, who are confused, who have a communicable disease, or who are considered vulnerable should not be eligible for admission. Admission to the discharge lounge should be voluntary. Patients who would rather remain in their rooms should be allowed to do so. 
• Guidelines for monitoring. Provide guidelines based on the developed patient selection criteria for monitoring patients who are waiting in the discharge lounge. Include regular rounding if the lounge is not staffed full time. Develop a process for managing medical emergencies and behavioral issues occurring in the discharge lounge.
• Documentation. Policies and procedures should provide clear guidelines for staff regarding documentation. Ensure that guidelines address how often documentation should occur and what should be documented such as monitoring checks, changes in condition, medical or behavioral issues that require intervention or unexpected delays.
• Mitigating unexpected delays. Ensure that policies and procedures include medication administration, provision of meals, and alternative transportation guidelines for patients whose lounge stay lasts longer than expected.

Establish workflows. Develop a process for communicating with nursing teams regarding which patients are eligible for daily admission to the discharge lounge. Establish a workflow to prioritize patients who are eligible for discharge. Create a method to keep track of patients who are admitted to the discharge lounge and when they expect to be picked up or discharged. Ensure that the patient list is updated when plans change or when discharge will be delayed.

Provide appropriate amenities. Patients may have to wait for several hours in the discharge lounge so it should be an inviting place to spend time. Provide comfortable seating, blankets, snacks, and beverages. Include entertainment options, such as television, books, magazines, and Wi-Fi. For extended wait times, consider providing cafeteria meal vouchers. Ensure that patients have a way to call for help if the lounge is not staffed full-time.

Set expectations. Patient satisfaction is linked to fulfilled expectations, so ensure that patients clearly understand the purpose of the discharge lounge and what to expect once there. Set expectations via brochure or signage. Clarify what the lounge is and is not, e.g., inappropriate for overnight or lengthy stays.

Designate personnel/coordinators. Determine how to staff the discharge lounge, e.g., with nursing assistants, volunteers, patient care technicians, etc. Clearly outline staff expectations, including specific job duties for when patients are in the lounge and after they are discharged, such as follow-up phone calls. Ensure that designated staff receives training appropriate for their skill set and that they have access to necessary resources. 

ED overcrowding is a widespread problem that shows no signs of abating. When well designed, discharge lounges can be an innovative, cost-effective way to relieve ED overcrowding by accelerating access to inpatient beds.