Latest / Becker’s Healthcare - Clinical Leadership Podcast / Rebecca Baute, BSN, RN, Chief Nurse Executive of Northwestern Medicine Palos Hospital, and 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, and Brittany Barasa, DNP, RN, Manager of Patient Care for Nursing Throughput and PCT Float Pool · Becker’s Healthcare - Clinical Leadership 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 Baudy, 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
  CCs,
• 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.