University of Michigan Medical School, Ann Arbor, MI; Harvard Business School, Boston, MA.
Harvard Business School, Boston, MA; Department of Medicine, Stanford Medicine, Palo Alto, CA.
Ann Emerg Med. 2020 Jun;75(6):704-714. doi: 10.1016/j.annemergmed.2019.12.002. Epub 2020 Jan 23.
Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only 3 peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed, and how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.
延迟为已入院患者提供住院床位会显著导致急诊部门（ED）滞留和拥堵，这与患者安全产生有害影响有关。为了加快住院床位的可用性，一些医院已经实施了出院休息室，允许已出院的患者在等待出院过程或交通完成的同时离开他们的住院病房。这篇概念性文章综合了与出院休息室实施实践和结果相关的证据。我们使用概念综合方法，通过查询 PubMed、Google Scholar 和 Google 并进行回溯参考文献搜索，审查了与出院休息室相关的医学和灰色文献。我们筛选了提供详细出院休息室实施情况的文章，或提供关于该主题的概念分析的文章。我们确定的大多数证据都来自灰色文献，只有 3 篇同行评审的文章专注于出院休息室的实施。文章通常包括单站点描述性案例研究或专家意见。出院休息室的目标、特点和对患者流量的明显影响存在显著的异质性。尽管已经记录了出院休息室性能的常见障碍，包括使用率低和护理团队反对，但提供的通用解决方案有限。总体而言，出院休息室被广泛认可为加速获得住院床位的机制，但有限的可用证据表明设计和性能存在广泛差异。需要进一步进行严格的调查，以确定在哪些情况下应部署出院休息室，以及如何设计出院休息室以最大程度地提高其对全院患者流量、ED 滞留和拥堵以及其他目标结果的影响。
