Decreasing Emergency Department (ED) Throughput Time by Using a Discharge Resource Room

Intervention Title: Decreasing Emergency Department (ED) Throughput Time by Using a Discharge Resource Room – Regional Medical Center at Memphis (the Med), Memphis, Tenn. Goal: Improve ED patient flow and decrease throughput time. Innovation: Staff created the Discharge Resource Room (DRR), an eight-bed area dedicated to providing discharge instructions and resources for inpatients to assist in preparation for their home care. Result: Approximately 60 percent of all medical/surgical patients are now discharged from the DRR. The new procedure, which provides an inpatient bed more rapidly, has had a significant effect on decreasing ED throughput time. Institution: Regional Medical Center at Memphis 877 Jefferson Avenue Memphis, TN 38103 P: (901) 545-7100 From the experts: β€œThe Discharge Resource Room really offers a great benefit to the patient and to the ED. Not only has the unit decreased its throughput time, but it has also improved patient satisfaction, assisted in alleviating overcrowding and, in turn, helped prevent staff burnout.”

Rhonda Nelson, M.P.A. VP of Patient Care Services

Profile: The Regional Medical Center is a 355-bed, acute-care teaching hospitallocated in Memphis, Tenn. Clinical areas affected:

  • Emergency department
  • Medical surgical units

Staff involved:

  • Registration
  • Nurses
  • Nursing Assistants
  • Physicians
  • Bed control
  • Transporters

Timeline: After garnering top-down buy-in from the hospital administration, the DRR was fully up and running in two months. Contact: Rhonda Nelson, M.P.A. VP of Patient Care Services P: (901) 545-7888

Innovation implementation: Many emergency departments face severe crowding issues, causing patients to line up in hallways waiting hours to be seen. One major cause of ED crowding is the unavailability of inpatient beds. High census within hospitals results in some patients spending days in the ED waiting to be admitted to an inpatient bed. Working to address throughput issues in its busy ED, a team at the Med created the Discharge Resource Room (DRR), an area to provide discharge instructions and resources in a comfortable setting for in-patients to prepare for their home care after discharge. The DRR occupies an eight-bed area located on the ground floor of the hospital with easy access to a circular drive for patient pickup. Staffing for the DRR consists of two parts. First, a registered nurse reinforces patient education and home care instructions and provides follow-up phone calls to discharged patients. Second, a nursing assistant transports patients from the inpatient floor to the DRR, assists with wheelchair transports to the patient's vehicle, and delivers pharmaceuticals and other discharge materials to patients as needed. Upon presentation to the DRR, the patient is considered technically discharged from the hospital. If a patient requires medical attention while in the DRR, the patient is transported to the ED for further assessment and evaluation. The admission criteria for the DRR are that the patient must a) have had discharge orders written by a physician, b) be able to sit in a recliner, c) have been physiologically stable for at least eight hours, and d) have achieved independence from therapeutic measures performed by nursing or support services such as IV therapy or Foley catheter, unless therapy will be continued at home with proper assistance. Patients are excluded from the DRR if they have a large prosthesis, are placed in a nursing home or are unable to sit in a chair. By implementing the DRR, the Med has improved patient discharge processes and experienced a substantial reduction in ED throughput time. This change has led to inpatient beds turning over more quickly and becoming available for admissions from the ED. The unit has also increased Med/Surg and ED staff morale and patient satisfaction. Advice and lessons learned:

  1. Top-down support is needed
  2. Nurse buy-in is critical
  3. Awareness is key.

Cost/benefit estimate: The DRR has dramatically decreased the ED's throughput time. Sixty percent of all medical/surgical patients are now discharged from the unit, an average of 15 patients per day or one-third of all hospital discharges. An average of 17 follow-up calls are made each day to all patients using the DRR. Calls are also made to approximately 10 percent of other discharged patients.

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