For decades, crowded EDs have led to staff and financial woes and, most importantly, poorer patient outcomes. Recent studies associate high ED census with longer inpatient length of stay and higher in-hospital mortality.
It’s clear that the problem can’t be solved in the ED alone. Without a plan that addresses hospital operations holistically, most approaches to decompress the ED and deliver better care are doomed to fail. For example, the NEDOCS score, used since 2004 to understand and predict overcrowding and boarding, simply isn’t robust enough to indicate true issues or drive action. Indeed, hospitals have seen the best results by starting at the end of the patient journey instead; focusing on discharge discipline triggered by AI-powered solutions and backed up by solid operational processes has led to dramatic reductions in ED boarding times.
To reduce ED boarding in an effective and sustainable way, hospitals must address issues with people, process and technology by moving up a pathway to optimization. Technology serves as a catalyst to necessary culture change by identifying bottlenecks, making predictions and fostering communication to reach this goal. Here are some real-world solutions that hospitals have used to solve the ED boarding problem, along with the improvements measured by focusing on home discharges, hardwiring alternative pathways to ED discharge and optimizing operations with the AI-powered platform iQueue for Inpatient Flow.
Focus on home discharges
The first step on the path to optimizing ED boarding involves focusing on discharges to home. While very few discharges are straightforward, patients discharged to home represent around 60% of all U.S. hospital stays and represent the clearest path to opening capacity and relieving stress in the ED.
With an AI-infused operations system, this goal becomes much easier to achieve. Care teams, now connected and communicating more effectively, can identify the full set of discharging patients who need focus today, and can rely on patient-level discharge predictions to drive discussion on individual patients during rounds and huddles to prioritize resolving barriers to discharge.
Baptist Health Arkansas saw its initial return on investment from this data-driven strategy soon after bringing its nursing, care management and logistics center teams together to focus on discharges to home. They did this by identifying and driving barrier resolution while working to more accurately predict census numbers and individual discharge dates. Through this work, Baptist Health’s ED boarding decreased 35% within the first year, in addition to seeing a nice halo effect: increased admissions, early discharges and transfers, along with decreased left-without-treatment-complete and diversion numbers.
Hardwire alternative pathways
In addition to expediting discharges to home, many organizations can impact boarding by avoiding utilization of their inpatient beds. This can occur through the use of alternative care programs that transition patients out of their ED stay. This may include the use of their hospital-at-home program, short-stay units, community hospitals or readmission care plans to avoid low-acuity inpatient admissions to their physical beds in the hospital.
This process becomes much easier to achieve by automating the identification of patients for these strategic programs. Care teams can then focus on expediting the review of those qualified placements, creating a better experience for staff and patients.
Hospitals around the country have seen utilization of their alternative care programs increase 10% or more. By focusing on home discharges and alternative pathways, Sarasota Memorial Health Care System achieved a 32% reduction in ED boarding hours while experiencing a 22% increase in visits.
Optimize operations broadly
As organizations mature, hospitals can continue optimizing ED boarding by getting out further ahead of the discharge process, ensuring readiness across all operational and ancillary teams.
With the confidence provided by previous results, both Baptist Health Arkansas and Sarasota Memorial Health Care System took a strategic approach to refining their discharge workflows, applying modern operations and manufacturing principles to eliminate unnecessary steps. Technology played a key role in this transformation. At Baptist Health, predictive tools helped identify patients likely to discharge the next day, allowing teams to prioritize key tasks—such as medication reconciliation and follow-up appointment scheduling—before the discharge order was even written. As a result, the system saw a 34% reduction in geometric mean length of stay (GMLOS) variance and a 25% decrease in opportunity days.
Similarly, Sarasota Memorial Health Care System optimized its discharge process by leveraging technology and operational efficiencies. These efforts led to a 13-hour decrease in length of stay, a 10% reduction in discharge processing time, and a significant shift in discharge timing, with 40% of discharge orders now written by 1 p.m.
By embracing data-driven insights and process improvements, both health systems enhanced patient flow and reduced ED boarding, demonstrating the impact of modern operational strategies on hospital efficiency.
Hear Baptist Health Arkansas and Sarasota Memorial Health Care System describe their paths to ED boarding improvement using AI-enabled automation in their own words from the recent Transform Hospital Operations Virtual Summit, hosted by Becker’s Healthcare and LeanTaaS.
