As executive director of logistics, capacity and patient throughput at Sarasota Memorial Health Care System (SMHCS), I’m privileged to have been part of a major AI-enabled transformation in patient flow over the last several years. This work has yielded impressive results—including a 13-hour inpatient length of stay reduction and an increase in daily discharges from 125 to 200—without compromising care quality.
These outcomes reflect a powerful combination of redesigning our processes, building the right infrastructure, and harnessing AI-powered technology. I firmly believe that any health system can adapt these steps to revolutionize their patient flow and see similar results to what we’ve achieved. Here are some key steps to how we combined people, process, technology and culture to drive change and achieve sustained success.
1. Analyze and align. In 2015, our team reviewed the average daily census of Sarasota Memorial Hospital, our system’s 897-bed flagship facility, for the last three years and saw what we called a “burning platform”—the inflow of patients was rising steadily as the local population increased. Inefficiencies in patient flow meant bottlenecks in the afternoon and an inability to discharge patients effectively.
This led us to run a kaizen event—a research and analysis session geared toward process improvement—that showed issues in four major areas: surgical services, the ED, patient discharge and intra-departmental patient flow. From that, we created a business plan proposing a 24/7/365 logistics center to orchestrate operations across these areas, with a goal of increasing capacity without compromising quality.
Our bet was that the increase in surgical volume enabled by this redesign would pay for the logistics center within two years. It did—in just six months.
This early alignment, including full board approval, laid the cultural groundwork that enabled our long-term success.
2. Establish a strong logistics center. The SMHCS logistics center became the focal point of our throughput strategy. Starting with an initial 12 full-time employees, it has since grown to 90 due to the depth of additional tasks that the center has taken on over the years. We centralized previously siloed functions and integrated operations across the main campus and our 212-bed Sarasota Memorial Hospital–Venice, which opened in 2022.
Seven different roles work inside the center, from expediters focused on breaking down patient discharge barriers, to coordinators responsible for determining every patient’s level of care prior to admission, to project managers who help us run continuous improvement initiatives. In conjunction with the inpatient units, the center also handles all bed placement and transfer activity. Centralizing this work was a critical step to creating a strategic discharge workflow.
3. Redesign discharge workflow. This work produced a slew of benefits for SMHCS and has been integral in our mission to create capacity. Our analysis revealed two major insights:
- Our core issue was a discharge vs. admission logjam around the 1 p.m. hour, and discharging 35-40% of patients before 1 p.m. would solve the problem.
- Seventy percent of discharges were “home/no needs” patients—that is, they needed relatively few things to be ready for discharge compared to the 30% of complex cases.
Our teams were inspired to action from this data. The logistics center would begin to facilitate the 70% of “home/no needs” discharges, while case management would continue to work the complex cases, both in conjunction with the inpatient units.
That’s not just a huge amount of tasks to coordinate—it also requires the need to identify which patients are likely to discharge today. Here, LeanTaaS’ iQueue for Inpatient Flow has played a major role by providing AI-powered, patient-level discharge predictions; alerting care teams to target discharge times and outstanding barriers for each patient; and enabling seamless communication across teams.
This technology was a great enabler to our people and process, both in the logistics center and across all departments. Morning “lightning rounds” could identify likely discharges and outstanding barriers to those discharges. Discharge expediters could work those barriers—for example, prioritizing a physical therapy evaluation with the PT team, or even discontinuing it if it was found to be unnecessary. Resource nurses could care for other patients on a unit while a bedside nurse prepped their patient for discharge. Logistics leadership could receive automated knowledge and suggestions if a patient exceeds a time-to-discharge goal. And while all of these tasks are happening, communication and updates on a per-patient basis are available for all to see in the iQueue platform.
4. Optimize the departure lounge. This often-overlooked hospital feature played a huge role in our success. By staffing our departure lounge with RNs, stocking it with furniture able to serve a diverse patient population and making the overall experience akin to an airline lounge, we have created the equivalent of a 30-bed unit without new construction.
With 85% of visitors coming from our main inpatient units, we now see over 240 visits per day, freeing nearly 22,000 hours of bed time a year from the units. A well-functioning departure lounge is a major lever to impacting throughput and capacity.
With all of this work, we have seen a significant return on our investment. We experienced the following in the first three months of creating our strategic discharge workflow:
- 13-hour inpatient length of stay reduction
- Increase in discharges from 125 per day to 200 per day
- ED admission wait time decrease of 50 minutes
Ongoing outcomes have been excellent and illustrate the cross-departmental benefits of creating capacity:
- Decrease in ED placement times by 105 minutes
- 86% OR first-case on-time start rate
- Order-to-discharge time decrease of nearly 120 minutes
Our success stems from a deep integration of people, process, technology and culture. Our clinical teams use fully mobile, AI-powered tools to coordinate more effectively. An in-house clinical capacity analyst monitors performance and identifies opportunities for rapid improvement.
Backed by strong leadership support, our culture remains agile and patient-centered—empowering us to continuously adapt and improve for the benefit of our patients.
To learn more about SMHCS’ inpatient flow transformation, join me at Transform Hospital Operations Virtual Summit on June 10-11, where I’ll be presenting on this work and answering questions. Register here.
