Until recently, the Regional Medical Center in Memphis (The MED) had been experiencing a crisis facing many of the nation's hospitals: ED overcrowding. But within the past year their ED throughput has been halved from eight hours to four hours.

This improvement helps to increase the number of patients the ED can assist and minimize the time patients wait for treatment.

Many factors have contributed to this dramatic reduction, including major changes in triage protocol, diagnostics, staffing and registration.

(See new MED protocols)

However, according to Rhonda Nelson, vice-president for patient care services at The MED, one of the most significant changes has been the creation of a Discharge Resource Room (DRR).

"We created the DRR about two years ago when we examined the reasons why patients were crowding the ED," says Nelson. "A lot of them want to stay for a meal, or don't have transportation home." She also adds that many patients were returning to the ED as a result of not taking medication prescribed during a previous visit.

Implementation

The DRR is fully integrated into the discharge process. First, a physician orders the discharge of the patient. Then, while the patient is being transported to the DRR, staff have prescriptions filled at the outpatient pharmacy. Once the patient arrives, the DRR nurse provides reinforcement of patient education, instruction for home care and medications from the pharmacy.

(See DRR nurse duties)

"Being able to speak with a nurse one-on-one enhances the patient education process," says Nelson.

The DRR nurse is also able to help arrange for patient transportation if necessary. Once the patient has been sent home, the DRR nurse will make a follow-up call within 24-48 hours to ensure that the patient is complying with physician instructions and taking medication.

"We always call back and also provide a phone number to the patient for questions after their visit," says Nelson. She points to this extra service as a key factor in The MED's recent increase in patient satisfaction, and a reduction in the number of non-emergent return visits.

Impact

Although obtaining initial buy-in from administrators was a challenging process, Nelson says that the results were self-evident. "Once we were able to bring administrators in to see how much better our throughput had become, funding was no longer an issue." The DRR adds value to the hospital because it improves patient care, enhances the patient experience and contributes to The MED's mission as a leading medical facility.

Patients have expressed a high level of satisfaction with the new facilities, although according to Nelson, it is sometimes a challenge to convince patients that they are not being "kicked out" of the ED when moving them to the DRR. The staff at The MED has found that a positive attitude can go a long way towards increasing patient satisfaction.

"It really does offer a great benefit to the patient, and to the ED," says Nelson. "I would encourage every hospital with a throughput problem to create a Discharge Resource Room.

Click here to download a PowerPoint presentation on the DRR at the MED.

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Rhonda Nelson
Vice President for Patient Care Services
The Regional Medical Center at Memphis