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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.