Innovative response to capacity crisis

Nurse manager Amy Marver, MSN, RN, reviews the after-hospital care plan with a patient in the Internal Discharge Lounge that was quickly stood up by nursing and coordinated care teams to free up hospital beds for patients in need

When a significant uptick in emergency department (ED) and inpatient volumes occurred at University Hospital in fall 2022, considerable strain was placed on care teams and system capacity.

To ensure that patients were getting the care they needed in a timely fashion, UW Health nursing and coordinated care teams flew into action by reimagining how they could continue caring for the community.

As a result, they quickly stood up an Internal Discharge Lounge that opened Oct. 13, 2022, as a small test of change to move patients who were ready for discharge to a safe place while freeing up inpatient beds for ED patients and transfers.

“Inpatient care teams were initially provided information about the lounge process,” said Connie Allen, MSN, RN, director nursing operations support, who helped coordinate the effort with frontline nurses, clinical nurse specialists, nursing education specialists and coordinated care colleagues. In addition, guidance was given to staff and providers on applying a new lens to consider each patient as a possible candidate for the lounge.

“The coordination of efforts throughout our ED and inpatient units to raise awareness was outstanding,” Connie said.

Becky Lovett, BSN, RN, care team leader and diabetes resource nurse for the General Internal Medicine Unit, was the first staff member to send a patient to the internal lounge.

“I had been in communication with the patient’s nurse, and together, we determined that the patient was eligible for transfer to the lounge,” Becky said. “The patient’s ride wasn’t coming until 4 p.m. that day and we got her to the lounge by 11 a.m. Connie was there and two of our nurse managers, Troy Betts and Amanda Toberman, escorted the patient to the lounge, which was so wonderful and kind.”

Becky admitted to hiccups along the way, but remembered wise words from the University Hospital CNO, Michele McClure, who said: “Don’t let perfection get in the way of progress.” And they didn’t.

“The communication and collaboration were seamless, as everyone pivoted left and right to make it happen,” Becky said. “Everyone worked together to figure it out as we went along. Being nimble is so important. We got a lot accomplished — the lounge was a fantastic idea.”

This innovative approach complements the existing External Discharge Lounge, located at the Best Western InnTowner hotel, which has been serving as a transitional option for University Hospital patients and families.

“We were extremely pleased to see the success of this effort in helping free up inpatient beds to ensure patients were receiving the right level of care at the right time,” Connie said. “Although our capacity issues continue to be concerning, this key improvement helps curb the strain.”

A few members of the team who sprang into action to set up and staff the Internal Discharge Lounge (left to right): Kyla Schoenwetter, DNP, RN, ACNS-BC, CCRN, clinical nurse specialist; Brittani Reinhardt, MSN, RN, CCRN, nursing education specialist; Amanda Toberman, BSN, RN, nurse manager; Nancy Leistner, MHA, RN, former director, coordinated care; and Tammy Wymer, MSN, RN, CCM, outcomes manager

Check out more stories featuring the great work of our nurses in the 2022 Nursing Annual Report (pdf).