Discharge Hospitality Centers: Throughput’s "Last Mile"

From COVID Necessity to Critical Capacity Mover 

Hospitals and health systems continue to struggle with capacity and patient flow issues as patient censuses continue to rise. These same throughput congestion problems have made it more challenging to sustain an optimized care and satisfaction experience for patients. Solutions for this twin conundrum facing healthcare providers involves combining operational capacity management technology and collaborative care relationships between facilities across the country, and even around the world. 

However, as the benefits of these solutions outside the four walls of a hospital are realized over time, there are also answers to unclogging patient traffic while keeping patients happy within the four walls of a single or multi-campus facility. They can be found in the overlooked, underutilized, or mis-utilized spaces within a hospital that can, at a minimum, be repurposed or redesigned and rebuilt if space is available. These spaces can be transformed into Discharge Hospitality Centers (DHCs), also known as Discharge Hospitality Lounges or Discharge Cafés. DHCs have recently increased in popularity, partly as a capacity-freeing response in the wake of COVID, but also because of further outcomes data from long-established DHCs that have demonstrated how well they work. (See DHC outcomes results below.)

DHCs & Capacity Management Technology – Opening Up Beds & Removing Bottlenecks 

Finding the elusive "open bed" is the laser focus priority of every healthcare facility. Anything that can be done -- without sacrificing patient care or safety -- to locate that available bed faster for patients coming through the ED (Emergency Department) or for a scheduled procedure has become the key to unlocking capacity. Hospitals and health systems that have flagged and improved patient flow process deficiencies, with the support of capacity management and real-time location system (RTLS) operational platforms, have been able to quickly identify open beds and/or accelerate decision making for opening up bed capacity at any step across the in-patient care journey. In fact, facilities that have been able to streamline bottlenecks in the discharge process at the back end of the patient flow progression, utilizing capacity management technology, can open bed access at front end admissions and even streamline patient volumes boarded in the ED.  

However, the “last mile” of the discharge process -- from the time a patient’s discharge order is formally recorded in the system to their time spent in the DHC to their departure from the facility -- can become a last chokepoint of throughput inefficiency and patient dissatisfaction. Moreover, DHC patient departure delays can potentially work against the discharge and early discharge milestone efficiencies achieved utilizing technology, such as PatientTracking: AutoDischarge^TM, if the DHC admission and departure process is not closely monitored, managed, and regularly reviewed. In fact, for facilities considering establishing a DHC for the first time (or initiating another effort after previous unsuccessful attempts), or seeking to further optimize operations of already existing discharge spaces or DHCs, integrated capacity management/RTLS technology can be expanded from managing cross-hospital operational patient flow and discharge to specifically surveilling DHC-related discharge operations, so the “last mile” of throughput and positive patient care impressions is completed successfully. Additionally, a capacity management technology-driven DHC can also serve as a critical patient overflow solution in the event of another public health crisis or disaster. 

The Automated DHC

The DHC component of the overall discharge process has its own set of steps and intricate dynamics (which can also change in real-time) as the final leg of patient engagement and departure from a facility. If the patient Length of Stay (LoS) is reduced and engagement experience is optimized while in the DHC (including patient post-treatment education and ensuring understanding of discharge instructions), the DHC can also serve as a valuable tool for enhancing post-hospitalization at-home recovery and medication adherence as well as mitigating risks of readmission. 

All the moving parts and participating stakeholders responsible for ensuring a DHC’s goals, milestones, and outcomes are successfully reached -- for both the patient and the hospital -- need all the help they can get to minimize errors in DHC and hospital team interactions, tasks, and process steps that can derail a DHC’s effectiveness. A structured, thought out plan for implementing a DHC, including all contingency scenarios for unforeseen circumstances at a per patient level and customized to a particular hospital or health system’s needs and culture, is a critical step; but keeping on top of and communicating the completion of each DHC-related action between care and logistics teams requires real-time visibility into those actions, including who, how, and when they are being performed, as well as how they impact newly-opened bed capacity patient placement opportunities.  

The effectiveness of DHC team planning, collaboration, and execution activities can be best supported with an integrated capacity management/RTLS operational platform with mobile capabilities and data analysis tools that can cover areas that include: 

• Identifying DHC patient eligibility criteria in advance of patient discharge clearance  
• Tracking patients screened and approved for DHC eligibility and transported to DHC by hospital care unit
• Ensuring DHC-related and unit/floor nursing care and patient logistics/flow teams closely communicate and collaborate on confirming movement of selected patients to DHC, engagement activities while they wait in the DHC, and departure of patients from the facility via ride pickups 
• Confirming prescribed medications and/or medical assistive equipment have been ordered and provided to DHC patients before they leave the hospital 
• Tracking DHC-designated patient movements from transport to, length of stay in, and exit from DHC and hospital  
• Sending alerts between nursing and logistics DHC teams on patient location status and movement instructions, as well as to broader facility care and operations teams on bed clean completion by EVS (environmental services) and open bed availability for incoming patients 
• Analyzing DHC daily and over time utilization data including patient sends, occupancy, LoS, hours open, interaction/engagement/experience satisfaction surveys, transportation pick-up time and costs (contracted third parties like Uber or Lyft for instance), and post-departure follow up health outcomes as well as cross-disciplinary team communication and decision-making data to adjust DHC activities for further streamlining efficiencies 
• DHC activity impact on increased/decreased nursing team stress/burnout levels  
• DHC impact on ED boardings and new patient admissions 

Technology-Driven DHC Effectiveness – The Numbers Don’t Lie 

There are a diverse range of hospitals and health systems that have had longer or more recent histories at attempting to stand up DHCs but are fully committed to their success, despite fits and starts along the way. Other facilities are still assessing whether they have all the needed criteria to make the move towards creating a DHC. Whatever category a healthcare facility finds themselves in, there is mounting evidence that automating the operations of these spaces with integrated capacity management and real-time location system applications are enabling a new level of breakthroughs in bed capacity and patient throughput efficiencies. 

Examples of a diverse range of hospitals and health systems utilizing these technologies to run their DHCs include multi-facility systems stretching across the Midwest and South, a combined academic and community facility system serving multiple Northeast states, and an acute care trauma center treating patient populations in bordering New England regions. DHC operational outcomes have included: 

Combined academic and community facility system serving multiple Northeast states: 

• increase in DHC patient utilization volumes from 769 to 6,578 in a little over three years 
• 208 inpatient bed days saved from more than 280 unit areas in less than three years, with 240 bed days saved by end of 2023 
• total of 4,959 DHC patients to-date with projected increase to 6,500 by end of 2023 
• total of $426,379 saved from DHC utilization  
• total of 5,265 hours (about seven months) recouped from DHC utilization  
• total of 280 access area hours gained back from DHC utilization 
• 125% increase in DHC patient volume from 2021-2022   

  Multi-facility system stretching across the Midwest and South: 

• 926 DHC patients to-date across two facilities 
• Average DHC patient LoS 36 minutes  
• 681.5 hours (about four weeks)/27.5 bed days saved across two facilities 
• 427.5 hours (about two and a half weeks) of free bed time, or over 17 admission days saved  
• ED boarding hours continue to decrease with range from 288-548 hours (about three and a half weeks)  
• Steadily rising % of discharge patients vacating/leaving DHC by 1PM with high of 23.6% to-date   

 Acute care trauma center treating patient populations in bordering New England regions: 

• Since opening first DHC in 2008, patient utilization went from 173 to 2,830 (1,214 so far in 2023)