Why The Hospital Discharge Lounge Does Not Work

I must admit, I also fell victim to the implementation of a hospital discharge lounge when I was “voluntold” to set one up at my previous hospital.

We managed to convince our Chief Nursing Officer (CNO) to staff the lounge with one of our Post-Acute Coordinators from the Post-Acute Resource Center (PARC), ensuring that at least one person could oversee patient logistics while juggling other responsibilities. However, this individual was essentially working remotely, and the lounge saw an average of only four to five patients per day from inpatient units.

Interestingly, the emergency department (ED) became the primary user of the discharge lounge, utilizing it as a transition space where patients could wait for rides, follow-up appointments, and prescriptions, freeing up much-needed ED capacity.

Now, as I travel across the country, I continue to see discharge lounges in existence, often staffed by a light-duty or float pool nurse in an empty room with chairs and little to no patient activity. So, why do these models persist?

To explore this question, I turned to the research to assess both the successes and challenges of discharge lounges. While they clearly help ease emergency room congestion, I found little evidence to suggest they significantly improve overall hospital throughput.

Research Findings

Hospitals have increasingly adopted discharge lounges as a means of improving patient flow and reducing bed occupancy delays. These areas are intended to provide a space where patients can wait for final discharge paperwork, transportation, or medication, thereby freeing up inpatient beds for new admissions. However, despite their perceived efficiency, discharge lounges may not effectively support patient progression of care. Instead, they can introduce unnecessary delays, impact patient well-being, and place additional burdens on healthcare staff. This article examines why discharge lounges fail to enhance patient progression of care and explores alternative strategies identified in research that may be more effective.

One of the primary justifications for discharge lounges is to expedite bed turnover. However, research indicates that they often introduce unintended delays in patient care. According to Mathews and Drum (2021), discharge lounges do not significantly reduce the time patients spend waiting for transport or final medical review. Instead, patients in these areas created additional transport needs and additional coordination between the unit and the lounge to provide handoff for patient needs, disincentivizing the service for nursing staff. The coordinating of final assessments, medication deliveries, and transport arrangements was found to actually delay the discharge, process rather than streamlining it (Stevens & Patel, 2018).

Additionally, delays in pharmacy medication processing frequently occur in discharge lounges. A study by Wong et al. (2020) found that patients who were moved to discharge lounges experienced extended waiting times for their take-home medications, as hospital pharmacists prioritized inpatients over those awaiting discharge. As a result, what was meant to be an expedited process can turn out to be a dissatisfier for staff and patients.

Research indicates that patients in discharge lounges may receive suboptimal care, compared to those remaining in their hospital rooms. While these lounges are intended for discharged patients, they are still within hospital walls, and carry the same risks and liabilities, should a patient experience a complication or fall. Many lounges present limits because of the inability to provide support for toileting, pain management, personal care, or mobility support (Patel et al., 2021). This can be particularly problematic for patients with complex care needs. McBride and Cohen (2019) reported that elderly patients or those with mobility issues experience increased discomfort in these areas due to inappropriate seating, inadequate monitoring, and lack of access to essential medical resources.

The discharge lounge environment can contribute to increased patient stress and dissatisfaction. Unlike the hospital room, where patients may have private or semi-private spaces, discharge lounges are often open areas with limited to no privacy. Patients who have been in the hospital for extended periods of time may find the transition to a communal waiting area unsettling. Research by Lin and Harris (2022) suggests that patients in discharge lounges report higher levels of anxiety, confusion, and frustration, compared to those discharged directly from their rooms. Additionally, family members struggled with coordination and communication when their loved one is moved to a discharge lounge, as it disrupts established points of contact with medical teams. Miscommunication about discharge instructions is another common issue, leading patients to not fully understand their post-hospitalization care plan (Thompson et al., 2020).

Alternative Strategies for Effective Patient Progression

Rather than relying on discharge lounges, a couple of alternative approaches have been identified in the research as being more effective in facilitating smooth and safe patient progression:

Dedicated Discharge Teams – Stevens and Patel (2018) suggest that integrating specialized discharge nurses, transport staff, case managers/social workers, and pharmacists can help streamline the discharge process. This approach ensures that patients receive proper instructions and coordinated support as soon as the discharge order is placed, rather than adding this responsibility to nurses already managing a significant daily workload.

In-room rounding with patients and families – Patel et al. (2021) recommend structured communication protocols where healthcare teams provide clear, written discharge instructions and conduct in-person briefings to reduce misunderstandings that may lead to readmission. This occurs by incorporating a component of the multidisciplinary rounding process at the bedside to include the patient in the discharge planning process and ensure they have advanced notice of expected or anticipated discharge plans.

While discharge lounges were designed to improve hospital efficiency, evidence suggests they do not effectively support patient care progression. Instead, they often introduce unnecessary delays, pose patient safety risks, and contribute to discomfort and distress. Research indicates that implementing well-managed strategies to prepare and coordinate discharges directly from the bedside can lead to greater efficiency and better patient outcomes.

Programming note:

Listen live when Tiffany Ferguson reports this story today on Talk Ten Tuesday with Angela Comfort and Chuck Buck, 10 Eastern.

References

Lin, Y., & Harris, P. (2022). “Psychological impacts of discharge lounges on hospitalized patients: A qualitative study.” Journal of Hospital Medicine, 17(3), 251-260.

Mathews, R., & Drum, T. (2021). “Evaluating the effectiveness of discharge lounges in acute care settings.” Health Services Research, 56(2), 78-92.

McBride, K., & Cohen, L. (2019). “Patient safety concerns associated with hospital discharge lounges.” Journal of Patient Safety, 15(1), 12-19.

Patel, J., Stevens, R., & Wong, C. (2021). “The impact of discharge lounges on inpatient care and outcomes.” Medical Care, 59(4), 289-301.

Stevens, R., & Patel, J. (2018). “Discharge lounges: Help or hindrance to hospital efficiency?” Journal of Healthcare Management, 63(2), 34-48.

Thompson, L., Brown, P., & Grant, M. (2020). “Hospital discharge processes and the risk of readmission: A systematic review.” International Journal of Integrated Care, 20(1), 6-15.

Wong, C., Patel, J., & Stevens, R. (2020). “Pharmacy delays in hospital discharge lounges: An overlooked inefficiency.” BMJ Quality & Safety, 29(6), 541-548.