The Discharge Lounge: A Patient Flow Process Solution.

BACKGROUND: Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage. LOCAL PROBLEM: Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting. METHODS: Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles. INTERVENTIONS: After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written. RESULTS: The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased. CONCLUSION: The DL is an effective tool to improve patient flow and decrease hospital overcrowding.

A randomized trial of a behavioral intervention to decrease hospital length of stay by decreasing bedrest.

BACKGROUND: Approximately half of hospitalized patients suffer functional decline due to spending the vast majority of their time in bed. Previous studies of early mobilization have demonstrated improvement in outcomes, but the interventions studied have been resource-intensive. We aimed to decrease the time hospital inpatients spend in bed through a pragmatic mobilization protocol. METHODS: This prospective, non-blinded, controlled clinical trial assigned inpatients to the study wards per routine clinical care in an urban teaching hospital. All subjects on intervention wards were provided with a behavioral intervention, consisting of educational handouts, by the nursing staff. Half of the intervention wards were supplied with recliner chairs in which subjects could sit. The primary outcome was hospital length of stay. The secondary outcome was the '6-Clicks' functional score. RESULTS: During a 6-month study period, 6082 patient encounters were included. The median length of stay was 84 hours (IQR 44-175 hours) in the control group, 80 hours (IQR 44-155 hours) in the group who received the behavioral intervention alone, and 88 hours (IQR 44-185 hours) in the group that received both the behavioral intervention and the recliner chair. In the multivariate analysis, neither the behavioral intervention nor the provision of a recliner chair was associated with a significant decrease in length of stay or increase in functional status as measured by the '6-Clicks' functional score. CONCLUSION: The program of educational handouts and provision of recliner chairs to discourage bed rest did not increase functional status or decrease length of stay for inpatients in a major urban academic center. Education and physical resources must be supplemented by other active interventions to reduce time spent in bed, functional decline, and length of stay. TRIAL REGISTRATION: ClinicalTrials.gov, HS-16-00804.

Tennessee Self-concept Scale scores of urban African-American women.

The Tennessee Self-concept Scale: Second Edition scores of 33 urban, African-American women were compared in a pretest-posttest design. The treatment was exposure to a 3-mo. literacy and social skills training program. Contrary to expectations, scores on just two subscales--Self-criticism and Physical Self--fell outside the average range. Also, Physical Self was the only scale score to change significantly (-3.83). These results suggest that self-esteem scores of urban African Americans were similar to those of women in the general population.