Strategy, Interventions, and Impact of a Health System-Wide Quality Initiative to Reduce Length of Stay

Amid rising health care costs and declining reimbursements, hospitals face mounting pressure to enhance financial sustainability. Reducing length of stay (LOS) offers a compelling strategy to improve care quality while simultaneously enhancing operational efficiency. As health systems integrate, there is a growing opportunity to reduce LOS through coordinated, systemwide efforts.

This study describes the implementation (August 2024-July 2025) of a multipronged LOS reduction initiative across 7 hospitals within a large academic health system. Interventions were based on prior evidence and internal best practice. We describe key design elements used before implementation as well as strategic barriers/enablers that were retrospectively identified after the study period are described. Preintervention versus postintervention performance was assessed using observed-to-expected (O/E) LOS ratios. Trends in discharge volumes and emergency department (ED) boarding times were assessed to examine the impact of LOS changes on throughput and capacity.

Across 283,517 discharges during the study period, systemwide LOS O/E ratio declined from 1.07 to 0.99 (P<0.001). Observed LOS decreased from 5.77 to 5.67 days (P<0.001), while expected LOS rose from 5.52 to 5.91 days. Discharges increased by 3863 (from 139,827 to 143,690, P<0.001). Mean ED boarding hours fell from 14.1 to 10.4 hours (P<0.001). The significance of these findings were replicated at hospital-level groupings, with the exception of mean ED boarding hours.

A coordinated, multihospital LOS initiative was associated with improved LOS performance and increased throughput, demonstrated by reduced LOS and ED boarding alongside higher discharge volumes.