Our mission at University Health is to increase the good health of the community through high-quality, compassionate patient care, innovation, education, and discovery. To deliver on that mission, patients need to move safely and efficiently through every stage of care.
Poor patient flow, emergency department backups, and limited bed availability can hinder that mission.
At University Hospital, our 716-bed Level 1 trauma center in San Antonio, we saw the need to enhance our EHR with new technology and processes to address these challenges, improve patient and staff satisfaction, and meet the mandate we’ve set for our population. The result of our efforts was measurable: shorter lengths of stay, less ED boarding, and a more predictable daily operating rhythm across the hospital.
Rising demand, tight capacity
As with most U.S. hospitals, our inpatient stays and ED visits have risen steadily; from 2024 through 2025, our adult admissions increased on average by about 400 per month, and ED visits rose by about 600. This led to a set of familiar outcomes – average ED boarding times of nearly 16 hours and adult inpatient lengths of stay (LOS) nearing seven days. The impact of this increasing pressure was also reflected in our patient and staff satisfaction scores.
The tools we had at the time kept us managing in hindsight. Static dashboards showed yesterday’s capacity and ED holds, but they didn’t point to the actions needed to serve the right patients at the right time. And while our EHR excels at front-line documentation, it didn’t provide us the foresight to anticipate house-wide status or incoming surges. We also tried ED-focused throughput projects to reduce triage time, but the gains were short-lived. After talking with LeanTaaS’ clinical and operational teams, we realized we needed a more holistic approach to fixing our throughput issues. One grounded in a simple truth: “ED sets the need, inpatient beds set the speed.”
People, process, and technology
We implemented LeanTaaS’ iQueue for Inpatient Flow in April 2025 with a clear goal: reduce adult inpatient LOS by a half-day. This was a tall order, and we knew technology wasn’t a magic fix. Without buy-in, trust, and process improvement, a new tool is simply another system, rather than a catalyst for meaningful change.
Key to the project was aligning our operational and IT staff from day one. Since patient flow is everyone’s responsibility, we assembled about 20 stakeholder teams from across the organization – from physicians to environmental services to EHR analysts to our CIO. This dovetailed into the establishment of a centralized command center shortly after go-live to keep those groups in close contact.
Confidence in solid data was instrumental to success as well. LeanTaaS’ staff worked extensively with us to stand up broad data sets and accurate AI models, making sure they were actionable and easy to use. This “pregame” work was absolutely essential to our go-live.
The foundation of trust that we built transformed our operations. The focus of huddles shifted from issue reporting to true discharge management. With our new AI-enabled strategic models, we could compare predicted vs. actual admissions and discharges, revealing where to allocate resources across the house to move patients safely through care. At the patient level, our care teams could now identify exactly which patients to focus on in order to move the needle, including system-flagged patients eligible to move into our discharge lounge and hospital-at-home programs.
Results, lessons learned, and next steps
The transformation we saw in nine months after optimizing our inpatient operations was remarkable. Not only did we meet our goal of reducing LOS by half a day, we also saw benefits radiate across the hospital: ED boarding time fell by 47% while our satisfaction scores rose. A few weeks after go-live with iQueue, our ED medical director was amazed to see no patients in the waiting room; this is just one of the experiences that cemented our successful work.
As we evaluated the early results, several lessons stood out:
- Trust and multidisciplinary alignment must come first. Technology alone won’t fix patient flow, but shared priorities and shared ownership will.
- When paired with the right workflows, technology can reveal gaps that are easy to miss. For us, increased visibility highlighted inconsistent documentation of barriers to discharge, an issue we were able to correct quickly.
- Surfacing meaningful data is vital. Instead of 20 dashboards, we depend on six or so indicators to tell us what’s happening, what’s about to happen, and where to focus our efforts.
- Expanding capacity isn’t the solution to poor patient flow; greater efficiency with what we already have is.
With sustainable results now visible across the organization, we’re focused on building on this momentum. Next, we plan to expand LeanTaaS’ solutions to our OR and infusion operations, bringing these practices to the three new hospitals we’ll open in the near future.
Ultimately, strengthening patient flow helps us deliver on our mission, providing timely, compassionate care to every patient who depends on us.
We’ll be diving deeper into the specifics and impact of University Health’s inpatient flow optimization work at Transform Inpatient Operations Virtual Summit on February 10, 2026. Register for the event here.
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