Introduction: Hospitals are under pressure to meet the ‘four-hour target’ for acute admissions. Achieving this can depend in part on bed availability; waiting for beds causes delays. Consequently discharge lounge facilities (where patients can wait for transport on discharge) have been created to improve patient flow. There are no guidelines for discharge lounge care. Owing to concerns about older patients' potential loss of dignity in our discharge lounge we developed local standards guided by the Preventing Abuse and Neglect in Institutional Care of Older Adults (PANICOA) study [Tadd et al. (2011, Department of Health)].
Change strategies: Using observations and clinical notes, 39 random discharge lounge users were audited between January and March 2011. As a result of our findings, the lounge was moved to an alternative setting. Staff were issued with guidance regarding the expected level of care and information for patients was produced. Following this, a further 40 users were audited in 2012 using the same parameters.
Change effects: For the 2012 cohort: assumed dependency levels, age and referrals from the Emergency Department the same. However, the 2012 cohort were better dressed: 87% clothed (77% in 2011), 80% wearing shoes (41% in 2011). Five waited over 210 min for transport (10 in 2011), 20 waited under 90 min (15 in 2011). Cognition was assessed more frequently; only 10% were found to be cognitively impaired (29% in 2011).
Conclusion: The audit showed some improvements in discharge lounge care. The majority of users are still older people, over 70 years. Many needed mobility aids and required care at home. Patients were more appropriately dressed and less cognitively impaired. There was improvement in waiting time to discharge though this remains long for some. There are still areas to address. We plan to review standards and re-audit next year.