Latest / Becker’s Healthcare Podcast / Rebecca Baute, BSN, RN, Chief Nurse Executive of Northwestern Medicine Palos Hospital & Brittany Barasa, DNP, RN, Manager of Patient Care for Nursing Throughput and PCT Float Pool

Transcript

Rebecca Baute, BSN, RN, Chief Nurse Executive of Northwestern Medicine Palos Hospital & Brittany Barasa, DNP, RN, Manager of Patient Care for Nursing Throughput and PCT Float Pool · Becker’s Healthcare Podcast

• 0:00
  Welcome to the Becker's Healthcare podcast. I'm Mariah
• 0:02
  Taylor, assistant editor, and I'm thrilled to be
• 0:05
  speaking with Becky Bauhdi, chief nursing executive
• 0:08
  at Northwestern Medicine Payless Hospital, and Britney Barasa,
• 0:12
  manager of patient care nursing throughput and PCT
• 0:15
  float pool. Thank you both of you for
• 0:18
  being here with me today. I'm really excited
• 0:20
  to learn more about your best practices for
• 0:22
  discharge lounges. But before we dive into that,
• 0:25
  I would love for you to introduce yourselves
• 0:27
  and tell us a little bit more about
• 0:28
  your background. Becky, how about we start with
• 0:30
  you? Thank you. Thank you, Mariah. I wanna
• 0:33
  first thank Becker's for hosting this podcast.
• 0:36
  Britney and I had,
• 0:38
  written an article for Becker's,
• 0:40
  a few weeks ago and we showed a
• 0:43
  lot of interest from all over the country.
• 0:44
  So I wanna thank Mariah and Beckers for
• 0:47
  hosting this podcast so we can share more
• 0:49
  of the great work that we're doing regarding
• 0:51
  our discharge lounge.
• 0:53
  So as Mariah said, my name is Becky
• 0:55
  Bowdy. I am the chief nurse executive for
• 0:57
  Northwestern Medicine Palos Hospital.
• 1:00
  I have been with Palos for the past
• 1:01
  two and a half years. I have experience
• 1:04
  as a chief nursing officer in several states
• 1:07
  throughout the country
• 1:08
  and have been privileged and honored to be
• 1:11
  able to set up discharge lounges
• 1:13
  in a few of the other organizations in
• 1:15
  which I've worked. So, thank you for having
• 1:18
  me today and I'll turn it over to
• 1:20
  Britney to introduce herself.
• 1:22
  Thanks. Thanks, Becky. And thanks, Maria. My name
• 1:24
  is Brit Barasta.
• 1:26
  I'm the manager of patient throughput here at,
• 1:28
  Northwestern Palos Hospital.
• 1:30
  Under patient throughput, as previously stated, I have
• 1:32
  the discharge lounge, the PCT flow pool, the
• 1:35
  nursing house supervisors,
• 1:37
  the staffing office, and as well as bed
• 1:39
  planner, you are, case manager nurses.
• 1:42
  My background is
• 1:43
  in critical care. I was a house supervisor
• 1:46
  for ten years, and I've been a manager,
• 1:48
  for about the last three years.
• 1:51
  Palos is my home. I've been here fourteen
• 1:53
  years in July. So very, very happy and
• 1:55
  excited to be here.
• 1:57
  Amazing. And we're so excited to learn more
• 2:00
  from both of you. I'm sure many of
• 2:01
  our listeners have read that article that was
• 2:04
  published a few weeks ago now about discharge
• 2:06
  lounges, what are what's working, what's not from
• 2:09
  systems across the nation.
• 2:11
  And as Becky said, a lot of people
• 2:13
  have been reaching out to people like Becky
• 2:16
  to learn more. And we've heard on the
• 2:18
  Becker side of things, a lot of leaders
• 2:20
  have attempted to try
• 2:22
  getting a discharge lounge off the ground and
• 2:25
  often often found it failing. Sometimes they try
• 2:27
  it multiple times and they're running into a
• 2:29
  lot of different issues. So in our conversation
• 2:32
  today, we're gonna be diving deeper into some
• 2:34
  of the best practices for setting up, getting
• 2:37
  your staffing in place, bottlenecks,
• 2:39
  and any other missing pieces.
• 2:41
  So Becky, how about you tell us a
• 2:43
  little bit more about what your best practices
• 2:45
  are for initiate for the initial setup for
• 2:49
  discharge lounges as far as the space, the
• 2:51
  location, and staff?
• 2:53
  Sure. So thank you. There there are multiple,
• 2:56
  actually, best practices for setting up the space
• 2:59
  first and foremost is the executive leadership support.
• 3:02
  You
• 3:03
  have to have support of the organization
• 3:05
  in setting up that, discharge lounge.
• 3:08
  And so we had that. It was very
• 3:11
  strong here. I know that most organizations throughout
• 3:14
  the country have throughput issues,
• 3:16
  particularly in their emergency department,
• 3:18
  and really expediting those trans,
• 3:21
  those discharges
• 3:23
  and having a place for our patients to
• 3:25
  wait that is comfortable is extremely important.
• 3:28
  And I will speak to the ROI a
• 3:30
  little bit later in this podcast.
• 3:33
  For us, it really worked to have a
• 3:34
  designated
• 3:35
  RN
• 3:36
  and a patient care technician, which we, refer
• 3:39
  to as PCTs.
• 3:41
  They are
• 3:42
  tenured. It's a tenured RN. They're comfortable.
• 3:45
  They have critical thinking skills because we do
• 3:47
  have patients that end up having to be
• 3:50
  readmitted because something comes up while they're waiting,
• 3:53
  for their discharge.
• 3:55
  The patient advocacy and the confidence,
• 3:58
  in working with the teams, they're respected by
• 4:00
  the teams,
• 4:01
  throughout the house.
• 4:03
  And they really know what to look for.
• 4:05
  They come in,
• 4:07
  ready to go in the morning. They know
• 4:09
  how to check the charts. They know who
• 4:11
  potential discharges
• 4:13
  are. They are aware of some of the
• 4:15
  bottlenecks that could be happening.
• 4:17
  I do wanna add to that it has
• 4:19
  been very helpful
• 4:21
  to have this team report to Brit's team
• 4:24
  and to Brit,
• 4:25
  because she does, as she mentioned, oversee
• 4:28
  our bed planners, our staffing office, our,
• 4:33
  and our our supervisors
• 4:34
  and our PCT
• 4:36
  float pool. So,
• 4:37
  Britt is very aware
• 4:39
  in the morning when she comes in and
• 4:41
  throughout the day,
• 4:43
  where our bottlenecks could be, where our patients,
• 4:46
  are being discharged from, where we're going to
• 4:49
  need beds. And she's able to keep up
• 4:51
  with that all day long because that's the
• 4:53
  work she does every day.
• 4:55
  So she is really our, manager at, you
• 4:58
  know, over command central of operations through the
• 5:01
  day at, Palos, and it has been very
• 5:04
  helpful to have her managing this team.
• 5:08
  We'll talk a little bit about the orientation,
• 5:10
  and Britt will expand upon that. It's very,
• 5:14
  critical to have a clear orientation so that
• 5:17
  our nurse and PCT knows exactly what's expected
• 5:20
  of them. They do work very independently.
• 5:24
  We did a lot of work with communication
• 5:26
  throughout our organization. So we have charge coordinators.
• 5:30
  Some hospitals refer to them as charge nurses
• 5:33
  who are responsible for daily operations on our
• 5:36
  units, And they have a critical role to
• 5:38
  play in identifying patients and also assisting the
• 5:42
  nurses on the units and getting those patients
• 5:44
  down to the,
• 5:46
  discharge lounge. So,
• 5:48
  Britt did help with the development and ongoing,
• 5:52
  work with our,
• 5:54
  cc's,
• 5:55
  and she will talk a little bit about
• 5:57
  that.
• 5:58
  We did a lot of education with our
• 5:59
  physician partners.
• 6:01
  They're the ones who are,
• 6:03
  are ordering the discharges. We know, you know,
• 6:06
  days ahead, we always say discharge planning
• 6:09
  begins at admission.
• 6:11
  And so just educating them with,
• 6:14
  being able to utilize this as a resource
• 6:16
  because many times they don't know
• 6:18
  maybe what's going on in the emergency department
• 6:21
  and we really have to have movement and
• 6:23
  we're starting to bottleneck.
• 6:24
  So just keeping them close is very important.
• 6:28
  The space just, related to the location, being
• 6:31
  close to an exit has been helpful for
• 6:33
  us. Our ambulance partners,
• 6:36
  and families are able to pull right up.
• 6:38
  They walk down a short hallway and the
• 6:41
  patients are right there. So they're not trying
• 6:43
  to maneuver through the organization. They don't have
• 6:46
  to stop at the front desk to check-in.
• 6:48
  They're really in and out, and that has
• 6:50
  been very helpful for us.
• 6:53
  So specialized training also for our discharge lounge
• 6:56
  staff. Again, Britt will talk a little bit
• 6:59
  more about the training.
• 7:01
  You need to have space to provide,
• 7:03
  medical supplies,
• 7:06
  etcetera.
• 7:07
  The, the space needs to be comfortable. Some
• 7:10
  of our patients are there for several hours.
• 7:13
  And so,
• 7:14
  we have quiet packs, which include earplugs, eye
• 7:18
  mask, crossword puzzles, things to keep them busy.
• 7:21
  You have to have access to a bathroom.
• 7:24
  And we have recliners, beds, and stretchers,
• 7:27
  which again, we will elaborate on a little
• 7:29
  bit, later related to knowing your patient population
• 7:33
  and really setting up the discharge lounge to
• 7:35
  handle that population.
• 7:37
  And then a non isolated space. As I
• 7:40
  said, our nurse and our PCT work very
• 7:42
  independently,
• 7:43
  but we do have patients
• 7:45
  that we might need help in turning,
• 7:48
  or they decompensate.
• 7:49
  And so having them, we have them in
• 7:52
  the middle of our, it's called our CSSC.
• 7:54
  It's like a, outpatient,
• 7:57
  recovery area.
• 7:59
  And,
• 8:00
  they are surrounded
• 8:02
  by other nurses and staff who can respond
• 8:04
  quickly if we need some help. So,
• 8:07
  that has worked out very well and to
• 8:10
  our favor a few times.
• 8:12
  So I think those are really the top
• 8:14
  best practices that we've identified. I don't know
• 8:16
  if Brit has anything else to add.
• 8:19
  Thanks, Becky.
• 8:20
  I'll just take a minute or two just
• 8:21
  to kind of expand on, a few of
• 8:23
  the points that you, spoke about, particularly regarding,
• 8:27
  I think our orientation and specialized training for
• 8:29
  the discharge lounge staff.
• 8:31
  So we worked very closely
• 8:33
  with
• 8:34
  our, discharge lounge PCT
• 8:37
  and RN to have them,
• 8:39
  feel comfortable
• 8:40
  taking care of the patients that are coming
• 8:43
  to the Discharge Lounge. So they did have
• 8:45
  an extensive
• 8:46
  orientation process.
• 8:48
  With that, continuing education is very important. So
• 8:51
  they both participate in our skills day that
• 8:53
  our med surg and step down nurses participate
• 8:57
  in yearly. So they're getting the same,
• 9:00
  type of training. They're getting exposed
• 9:02
  to the products, the patients,
• 9:04
  a vast variety,
• 9:09
  of tools so they can be successful in
• 9:11
  taking care of these patients safely when they're
• 9:13
  in the discharge lounge.
• 9:15
  Additionally, we recognize they are helping a lot
• 9:17
  of patients into vehicles. They're turning a lot
• 9:19
  of patients. They're taking care of patients from
• 9:22
  nursing homes. So we did have them work
• 9:24
  with our physical therapy partners to get specially
• 9:26
  trained, especially in body mechanics. So
• 9:30
  boosting patients, moving patients from stretchers to wheelchairs,
• 9:33
  specifically
• 9:34
  moving patients into vehicles, not just cars, into
• 9:38
  trucks, into SUVs.
• 9:40
  We purchased special equipment that we have in
• 9:42
  our discharge lounge
• 9:43
  to
• 9:44
  help assist the patients for the safety of
• 9:46
  the patient and for the safety of our
• 9:48
  staff. So we have bariatric walkers. We have
• 9:51
  gait belts. We have two different sized steps
• 9:53
  to safely help patients get in, depending on
• 9:56
  what type of vehicle their family
• 9:58
  members are coming to pick them up in.
• 10:00
  So we really try to encompass
• 10:02
  all things,
• 10:03
  to make sure that we're keeping our our
• 10:05
  patients and our and our staff, safe in
• 10:08
  the discharge process.
• 10:10
  With that, we also kinda talked about our
• 10:12
  charge workshop.
• 10:13
  So we hold quarterly charge workshops here at
• 10:16
  Palos, where we invite our charge nurses to
• 10:18
  come, and a variety of topics are discussed,
• 10:21
  but the discharge lounge has kind of been
• 10:23
  a standing agenda item at that charge workshop.
• 10:26
  It's really been great. I bring our nurse,
• 10:29
  to that workshop, and we have a nice
• 10:31
  presentation
• 10:32
  where we talk a little bit about the
• 10:34
  lounge.
• 10:35
  We we talk about inclusion criteria, exclusion criteria,
• 10:38
  and then we really open it up to
• 10:40
  have an interactive experience where we allow the
• 10:43
  charge nurses to really ask questions and speak
• 10:45
  with our discharge lounge nurse, go over examples,
• 10:48
  go over scenarios of what type of patients,
• 10:51
  you know, would be appropriate to send there,
• 10:54
  allow allow the staff, to ask any questions
• 10:57
  that they might have. And I really think
• 10:59
  having that open communication and that teamwork
• 11:02
  and the camaraderie
• 11:03
  has really assisted in our lounge being successful
• 11:07
  and get empowering the floors to send us
• 11:10
  their patients. They're entrusting that our staff can,
• 11:13
  you know, take great care of our patients
• 11:16
  through the discharge process.
• 11:18
  And I I wanted to, add one more
• 11:21
  point just in case it's not known. So
• 11:24
  we call it our discharge lounge. Most of
• 11:26
  our patients come down there and they are
• 11:28
  not they have discharge orders,
• 11:31
  but we transfer them down there. And so
• 11:33
  that has really worked well for us. And
• 11:35
  so they're actually being
• 11:37
  discharged as far as their education
• 11:40
  and their AVSs. They're they're being discharged by
• 11:43
  the discharge lounge nurse,
• 11:45
  which has really helped the staff up on
• 11:47
  the units,
• 11:48
  because that they transition
• 11:51
  or,
• 11:52
  do safe handoffs with our discharge lounge nurses,
• 11:55
  and they're actually discharged from the discharge lounge.
• 11:59
  Excellent. Those are great best practices, and I
• 12:02
  know we've got some more coming up.
• 12:05
  Britney, could you speak a little bit more
• 12:07
  to some of the best practices that have
• 12:09
  been successful to improve throughput and prevent any
• 12:12
  bottlenecking?
• 12:13
  Sure. I'd be happy to.
• 12:15
  So I think one thing that Payless definitely
• 12:17
  focuses on is our throughput here. So in
• 12:20
  the morning, we have a safety huddle where
• 12:23
  we
• 12:24
  proactively discuss any bottlenecks that we foresee might
• 12:27
  be happening for our day, here at Payless.
• 12:30
  So whether that's related to maybe having holes
• 12:32
  in our emergency
• 12:33
  department or maybe we're gonna have a heavy
• 12:35
  surgical admission day. So we really try to
• 12:38
  be proactive in identifying those bottlenecks. And then
• 12:40
  we take that and we work with our
• 12:42
  staff in the Discharge lounge to try to
• 12:44
  focus on getting patients down from those units
• 12:47
  that may be having those bottlenecks.
• 12:50
  The discharge lounge staff comes in. Our our
• 12:52
  lounge is open nine to 05:30, Monday through
• 12:54
  Friday. So they start their day, and they
• 12:56
  look at all the patients with current discharge
• 12:58
  orders. We have a Teams chat that we
• 13:00
  use here at Payless, which I feel like
• 13:02
  has been very successful,
• 13:03
  where the discharge lounge staff manages it. All
• 13:06
  the charge nurse and relief charge nurses have
• 13:08
  access to the chat, and the discharge lounge
• 13:11
  staff types in the chat patients that are,
• 13:14
  discharge orders.
• 13:15
  And we use more of a pull system,
• 13:18
  meaning
• 13:19
  the discharge staff identifies the patient and types
• 13:22
  in the chat and says, we recognize this
• 13:24
  patient, you know, has a discharge order. Doesn't
• 13:26
  look like there's anything left to do. Let's
• 13:28
  have that patient come down to the lounge.
• 13:30
  If there is something that needs to be
• 13:32
  done, like Becky mentioned,
• 13:35
  previously, maybe education needs to be done. Maybe
• 13:38
  the ABS needs to be printed.
• 13:40
  Then we can go ahead and do that
• 13:43
  in the discharge lounge for those nurses.
• 13:47
  So that has been a really great asset
• 13:49
  that it's been become more of a pulling
• 13:51
  system where our staff in the discharge lounge
• 13:53
  is trying to identify patients and then bring
• 13:55
  them down to the units. In times where
• 13:58
  we may have a lull, maybe we don't
• 13:59
  have a lot of patients in our discharge
• 14:01
  lounge,
• 14:02
  the staff from discharge lounge will go up
• 14:04
  and round on all of our units. So
• 14:05
  that's just to provide support. They can round
• 14:07
  on patients with discharge orders, and they can
• 14:10
  assist with the discharge up on the unit,
• 14:12
  or they can just go ahead and then
• 14:14
  take the patient down with them and bring
• 14:17
  them back to the lounge.
• 14:19
  Another thing that we really try to encompass,
• 14:22
  and this is, working with our physician partners
• 14:25
  in in a multiple in a multiple disciplinary
• 14:27
  approach,
• 14:28
  is during our MDRs,
• 14:30
  we hold here at Palos. MDRs are multidisciplinary
• 14:33
  rounds where the managers of the units round
• 14:37
  on,
• 14:38
  all the patients.
• 14:39
  It's the managers. It's the charge nurses. It's
• 14:42
  the our physician hospitalist partner. We have care
• 14:45
  coordination there. We also often have our physical
• 14:47
  therapist. They're rounding on patients, and they're discussing
• 14:50
  patients
• 14:51
  that have discharge orders. They're also discussing any
• 14:54
  types of barriers that they may have.
• 14:56
  Additionally, the discharge lounge is also always brought
• 14:59
  up. So if they discuss, can this be
• 15:01
  this patient be sent to the discharge lounge?
• 15:03
  If yes, then we go ahead and we
• 15:05
  use that Teams chat that we spoke about
• 15:07
  and we type in the Teams chat, let's
• 15:09
  send this patient down to the discharge lounge.
• 15:11
  So we've really tried to educate
• 15:13
  all of our partners,
• 15:15
  not just nursing in in what the lounge
• 15:18
  can,
• 15:19
  do, can accomplish in order to safely discharge
• 15:22
  our our patients.
• 15:23
  I think another thing that we
• 15:25
  have always been apprised to here is we're
• 15:28
  always updating and reviewing our criteria of what
• 15:30
  type of patients can come to our lounge.
• 15:32
  When we first have sanded our lounge back
• 15:35
  with the research of of COVID, I think
• 15:37
  we really were just trying to help alleviate,
• 15:41
  bottlenecks in the ER and and getting home
• 15:43
  home patients down there, patients that are going
• 15:45
  home. We recognize here in our geographical area,
• 15:48
  we have a very high geriatric patient population
• 15:51
  mix. So we really needed to alter our
• 15:53
  criteria
• 15:54
  in order to make it, successful
• 15:57
  and safe for the patients. So we've expanded
• 16:00
  on our criteria several times here, at Payless
• 16:03
  to include, we take nursing home patients. And
• 16:06
  like Beck Becky referenced, we expanded to be
• 16:08
  able to actually do the discharge in the
• 16:10
  discharge lounge. So we can do discharges, we
• 16:13
  can provide education,
• 16:14
  patients can still get,
• 16:16
  fed, they can still get their,
• 16:18
  medications orally. So we've really tried to expand
• 16:21
  on criteria
• 16:22
  based on the needs,
• 16:24
  of of the hospital.
• 16:26
  Additionally,
• 16:27
  we recognize that our, lounge has become more
• 16:31
  and more popular for use. We currently only
• 16:33
  have five bays.
• 16:34
  So some days we were seeing that we
• 16:36
  were full. So we recently just this year
• 16:36
  also implemented a surge pilot criteria.
• 16:38
  We
• 16:39
  recently
• 16:41
  just this year also implemented a surge pilot
• 16:41
  criteria,
• 16:42
  where we can surge and make one of
• 16:44
  our rooms,
• 16:46
  actually a surge room where we can take
• 16:47
  three patients all at once in one room.
• 16:50
  So again, we're just always reviewing
• 16:52
  criteria
• 16:53
  and
• 16:54
  expanding on,
• 16:55
  the needs of of the hospital.
• 16:58
  We've also expanded to be able to take
• 16:59
  outpatients. So we can also take patients from
• 17:02
  our cardiac cath lab, our interventional radiology department,
• 17:05
  anything to just help with throughput, not just
• 17:08
  from the inpatient perspective, but from the outpatient
• 17:10
  perspective as well.
• 17:12
  Excellent.
• 17:13
  And I think it's very clear that setting
• 17:15
  up a discharge lounge takes a lot of
• 17:18
  thinking, a lot of different elements, all coming
• 17:21
  together and working just right.
• 17:23
  And I think we've done a great job
• 17:24
  of kind of going over the space, location,
• 17:26
  the staff, the education, throughput.
• 17:29
  But, Becky, is there any other missing pieces
• 17:31
  that could prevent a new discharge lounge from
• 17:33
  being
• 17:35
  successful? I really cannot stress enough that,
• 17:38
  the importance of communication
• 17:40
  around the discharge lounge and really helping,
• 17:44
  really interdisciplinary
• 17:46
  teams understanding the why of the discharge lounge.
• 17:49
  Because many times it's to decompress the emergency
• 17:52
  department. And I would say most of the
• 17:53
  time.
• 17:54
  We have a lot of interdisciplinary
• 17:56
  teams that don't know we're holding
• 17:58
  40 patients,
• 18:00
  you know, in the hallways in the discharge
• 18:02
  lounge or in that emergency department. So it's
• 18:05
  very important,
• 18:06
  for the reasons that, Britt has already
• 18:09
  addressed to really make sure that we're covering
• 18:12
  all our basis and that everyone understands the
• 18:15
  why.
• 18:16
  I think that pool,
• 18:18
  model is has been very effective for us
• 18:21
  in not waiting for patients to be sent
• 18:23
  down and really helping and working alongside the
• 18:26
  staff
• 18:26
  and having that discharge nurse,
• 18:29
  go up and really help educate and help
• 18:32
  get those patients down.
• 18:33
  So,
• 18:35
  that's really, I think, one of the really
• 18:37
  important points.
• 18:39
  One of the other questions that we had
• 18:41
  had from the article was the ROI. And
• 18:44
  so I know that that's always challenging,
• 18:48
  in bringing on any additional FTEs or adding
• 18:52
  FTEs,
• 18:55
  for all of us,
• 18:56
  that can be very challenging.
• 18:58
  And, really, the ROI is really a downstream
• 19:01
  effect on what is happening to those patients
• 19:04
  in the emergency department that are in the
• 19:06
  hallways.
• 19:07
  So we know that the quality
• 19:09
  is not as good because the emergency department
• 19:11
  is already,
• 19:13
  overburdened and over overcapacity
• 19:15
  at that point.
• 19:17
  The patient satisfaction,
• 19:19
  is diminished.
• 19:21
  There's, you know, a lack of privacy sometimes.
• 19:24
  It's very challenging
• 19:26
  to help those patients maintain privacy,
• 19:29
  and being able to care for them effectively.
• 19:31
  So a lot of those downstream,
• 19:35
  benefits of having a discharge nouns are really
• 19:37
  related to preventing some of the,
• 19:40
  penalties that CMS,
• 19:44
  applies when you don't have strong patient satisfaction
• 19:47
  scores or,
• 19:49
  privacy rules and things like that. So there
• 19:52
  are many ways.
• 19:54
  We have 4.2
• 19:55
  FTs managing our discharge lounge, and the ROI
• 19:58
  has been well worth the money to manage
• 20:00
  that discharge lounge.
• 20:04
  Amazing.
• 20:05
  Well, thank you both for being here today
• 20:07
  and for sharing more about your success
• 20:11
  and how to get a Discharge Lounge up
• 20:11
  and running. So appreciate it, and I'm sure
• 20:14
  that our audiences have learned so much from
• 20:16
  this.