Rethinking Length of Stay: Reducing Harm Across the Care Continuum

This article is a sneak peek of the “Reducing Harm by Reducing LOS” session offered at the Breakthroughs 26 conference, exclusively for Premier members.

For health systems facing persistent capacity constraints, length of stay is an obvious place to look for opportunities to improve efficiency. But length of stay isn’t limited to the time a patient spends in a hospital bed. From the emergency department through inpatient care and into post-acute settings, delays at any point in the care journey can affect how efficiently and safely patients more through the system.

Reducing unnecessary delays can free up beds, improve throughput and help manage costs at a time when healthcare organizations are being asked to do more with limited resources.

But length of stay is more than an operational or financial metric. It is also an important component of quality and patient safety.

When patient flow slows, the effects can ripple across the care continuum. Patients may spend more time waiting in the emergency department, remain in the hospital after they are medically ready to transition, or experience delays moving to the next appropriate care setting. At the same time, those delays can make it harder for other patients to access needed care.

However, the goal isn’t simply to make every hospital stay shorter. It’s to identify and eliminate unnecessary delays, so patients can safely move to the right level of care at the right time.

Look Beyond the Length of Stay Number

Length of stay tells healthcare leaders how long patients remain in a particular setting. It doesn’t necessarily tell them why. That’s where the more important questions begin.

What prevents a patient from moving forward? Is it a process that could be streamlined? A test or consultation that is still needed? Variation in clinical practice? A discharge process that could begin more quickly? An authorization delay? Transportation? Availability of the appropriate post-acute care setting?

At Northwest Hospital, leaders took a closer look at the processes influencing emergency department throughput and identified opportunities across triage, staffing, bed placement, telemetry availability and escalation processes. Working with frontline staff, the organization improved door-to-provider time by 49 percent and overall length of stay by 25 percent. The hospital also reduced the number of patients who left before treatment was complete by 70 percent.

But the work also reinforced a broader lesson about improving patient flow.

“We learned that you can’t work on the emergency department in a silo,” said Danielle Geier, Director of Quality Improvement at Northwest Hospital. “We had to also work on the inpatient length of stay pieces, because if you’re not getting patients out, you can’t move patients out of the emergency department.”

Improving length of stay, in other words, starts with looking beyond the top-line number and understanding the sources of friction behind it.

Follow the Patient Across the Care Continuum

That same principle extends beyond the emergency department. A patient’s journey may begin in the emergency department, continue through an inpatient unit and ultimately transition to home, a skilled nursing facility or another post-acute setting. A bottleneck at any point can have consequences elsewhere.

“This is really a continuum,” said David Northern, Director of Performance Improvement at University Hospitals. “There’s a continuum from when the patient walks in the door and how this whole continuum plays out to reduce harm for patients throughout their stay.”

That means health systems may need to take a broader look beyond their own walls when evaluating patient flow.

At Cooper University Health Care, Max Kursh, Administrative Director of Community and Population Health, focuses on improving length of stay in the post-acute setting. Cooper has worked with skilled nursing facilities, physicians and advanced practice providers (APPs) to support more seamless referrals and acceptance of patients while regularly reviewing quality and length of stay metrics.

Taken together, these experiences point to a larger opportunity for healthcare leaders: Follow the patient, don’t limit focus on the department. Improving one point in the journey without considering what happens upstream and downstream can simply move a bottleneck elsewhere. A more comprehensive approach considers how patients move from the front door through discharge and into the next appropriate care setting.

Technology Can Help, but It Isn’t an Easy Button

As health systems look for new ways to improve capacity and patient flow, technology can provide valuable support. Artificial intelligence (AI), capacity management tools, command centers and real-time dashboards can help organizations identify bottlenecks and make information available more quickly.

But technology works best when it supports a strong improvement strategy rather than serving as the strategy itself.

“I think sometimes the easy button is, ‘We’re going to bring in AI to fix this problem,’” said Dr. Paul Entler, Chief Quality and Patient Safety Officer at Memorial Healthcare System. “That may help, but it’s likely going to fail if you don’t have the infrastructure underneath it and a strategy to identify the key levers.”

Those fundamentals often come back to people and processes. For Geier and the team at Northwest Hospital, that meant bringing frontline team members directly into the improvement process.

“Frontline engagement takes a lot of time, and people need to rearrange their schedules,” said Geier. “But we really needed that input for it to be successful.”

Physician engagement, leadership alignment and accountability can be equally important. As health systems redesign processes, the people doing the work every day can help identify where barriers exist and whether proposed solutions will work in practice.

Technology can enable that work. But it can’t replace it.

Turn Data into Action

Data is essential to understanding patient flow. But another dashboard alone won’t move a patient through the system. The value comes from using data to identify variation, challenge assumptions and determine where action is needed.

At University Hospitals, that has included giving clinicians visibility into length of stay performance at the provider level.

“We have pretty full transparency,” said Northern. “We expose provider names. You can see exactly what an individual’s length of stay is and what their observed-to-expected performance is. I think that’s valuable.”

Cooper has taken a similar approach with its post-acute network, using scorecards for sites, physicians and APPs to track performance and support accountability. And at Northwest Hospital, leaders receive daily reports and participate in daily safety huddles, so teams can respond if performance begins moving off course.

Data can also help health systems test assumptions that might otherwise stand in the way of improvement.

University Hospitals, for example, analyzed whether reductions in length of stay were associated with higher readmissions.

“We didn’t see a statistically significant increase in readmissions because our length of stay decreased,” said Northern. “The whole purpose of that analysis was to take that off the table as an excuse.”

The takeaway isn’t that a shorter stay is automatically a safer stay. Rather, health systems can use their data to test long-held assumptions and better understand the relationship between efficiency, quality and safety.

Optimize for the Right Stay

There is an important distinction between reducing length of stay and rushing patients through their care.

Some patients need additional time in the hospital. Others may be medically ready to leave acute care but need additional services or an appropriate post-acute setting before they can safely transition.

But additional days in the hospital aren’t automatically safer, either.

“Those extra days can give rise to harm for patients in terms of complications and other things that keep them there longer,” said Northern. “It’s a balance of how to best manage it for safety.”

That balance gets to the heart of effective length-of-stay improvement. Rather than stopping at, “How do we reduce length of stay?”, healthcare leaders can ask a more meaningful question:

“What is preventing this patient from safely moving to the next appropriate stage of care?”

Answering that question requires looking across the care continuum, identifying sources of unnecessary delay, engaging the people closest to the work and using data to continually evaluate where opportunities exist.

Ultimately, reducing harm isn’t about achieving the shortest possible stay at any one point in the patient’s journey. It’s about helping patients receive the care they need, where they need it, without unnecessary delays.

Continue the Conversation at Breakthroughs 26

Leaders from Northwest Hospital, Memorial Healthcare System, University Hospitals and Cooper University Health Care will share more about their approaches to reducing harm and improving patient flow during their “Reducing Harm by Reducing LOS” session at Premier’s Breakthroughs Conference.

Join the session to hear these healthcare leaders share how they are addressing patient flow across the care continuum — from the emergency department and inpatient setting through post-acute care — and the lessons other health systems can apply to their own improvement efforts.

For more:

• Join us at Breakthroughs 2026 and discover how the nation’s leading health systems are advancing clinical excellence, unlocking financial performance, transforming the workforce and building intelligent supply chains at Premier’s signature conference, exclusively for Premier members.