Improving the Royal Free discharge lounge

Overview

The Royal Free Hospital improved its discharge lounge to achieve better patient experience and increased patient flow, by allowing more medically fit patients to be transferred from the ward while they wait to be discharged.

What the organisation faced

In 2022, leaders at the Royal Free Hospital looked to make improvements to its discharge lounge to facilitate better patient flow and improve patient experiences. During the initial stages of this process, the standard operating procedure (SOP) was examined, and was concluded that it was no longer fit for purpose given the post-COVID-19 operational conditions.

Improvement

After reviewing version one of the SOP, it was rewritten to introduce a ‘pull model’ from wards to the discharge lounge to take advantage of the co-location with the hospital’s transport providers. This saw the team begin finding eligible patients proactively from the transport list as well as collecting them from the wards. Version two of the SOP was then developed, which saw the discharge lounge complete final dose IVs, provide hot meal services, and increase the criteria for patient eligibility.

Additionally, a successful funding bid  secured capital for the discharge lounge refurbishment, which has been used to expand the capacity and improve the aesthetics of the discharge lounge.

To support the implementation and adoption of the new expanded discharge lounge, there was a distinct focus around patient collaboration and team engagement. As such, through engagement with staff and service users, a set of clear objectives, aims, and target improvements were identified that aligned with the larger picture of patient flow at the hospital.

Outcome

All patients leaving hospital no longer need to wait on the ward for transport, medication, or paperwork, they can now come to the new lounge and wait in comfort allowing their vacated ward bed to be made ready for a new patient coming into the hospital. The improved discharge lounge now offers patients access to hot meal services, so they no longer have to wait for breakfast/lunch in the inpatient acute areas. There is also a self-service refreshment area to promote independence and prepare patients mentally for the transition of leaving the acute setting, providing much greater comfort during their stay in the lounge.

The improvements have also helped enhance the capacity of the discharge lounge. Previously the capacity was for ten ambulatory chairs and two recliners, but with the capital funding, the trust was able to redesign the existing area and increase the capacity to 19 ambulatory chairs, four recliners, one bariatric chair and one stretcher bay.

Since the launch of the new SOP, focus on team engagement and expanded eligibility, the team has achieved a 177 per cent increase in patient attendance, and on average now handles 27 patients per day, compared to ten previously.

In June 2023, 535 patients passed through the lounge, which is the highest recorded at the site. This was closely matched the following month in July, with just over 500 patient attendances.

Week-on-week usage of the discharge lounge from August 2022 to July 2023.                                      

The positive effects of the improvements extend far beyond the discharge lounge attendance numbers. Kyle Harding, operations manager for patient flow and site operations at the hospital noted: “We have observed and felt earlier flow throughout our trust, leading to clearer and more definite plans for elective recovery activities, ITU step downs and emergency access flow.

“Personally, I am really excited about the positive impact that the interventions to date have had on the discharge lounge everyday operations and on patient flow. We continue to see improvements month on month, and I encourage other trusts to consider investing time and resource into your discharge lounge team. Our journey will continue, and it is still very early days for us but efforts in this area can yield substantial benefits in patient flow and operational efficiencies.”