With increasing pressure on hospital beds today, the discharge of patients from the hospital setting needs to be examined, too. Patients require discharges of ever greater complexity, usually with
in-depth social care packages needing to be set up at home.
The majority of hospitals have introduced electronic discharge but, as any ward nurse knows, this process takes place after ward rounds in the morning and it can take a long time to obtain all the required parts of the discharge.
For example, medical staff will usually only be able to complete their part after they have completed the entire ward round. Obtaining patients’ tablets from the pharmacy department can take longer still, and if you add patient transport into the equation, the delays get longer.
The above reasons have led most hospitals to introduce discharge lounges, which are usually a small area of the hospital in which patients can wait to be picked up by the hospital transport.
The system should be turned on its head. The discharge lounge should be an integral part of the hospital system and not used just as a waiting point. As soon as the patient is selected for discharge by the team on the ward round in the morning, provided all other members of the multidisciplinary team are in agreement, the patient should be transferred at once to the discharge lounge. This should be looked on as an internal hospital transfer.
Once in the lounge, patients’ care can be continued by nursing staff while their discharge is being finalised.
The pharmacist, doctors and nursing staff can then complete the discharge on the computer in the discharge lounge. This means the medical staff will not have to visit a dozen wards to find their discharge patients after rounds, pharmacy have only one point to send TTAs to, and transport have a single collection point.
Just as there is an area of the hospital that patients are seen in on their immediate arrival – be it either the A&E department or on an acute assessment unit – so the discharge from the acute sector should be conducted within a specialist unit, namely the discharge unit.
James Bird is a charge nurse in A&E, St Mary’s Hospital, London