PV: What advice would you give to other places that struggle with boarding? 

PS: I think it begins with leadership. They need to come in on the weekends in particular. When you think about it, you have quite a bit of capacity to do things for patients on two out of seven days, and most institutions just don’t use them. The work we’ve done here, without question, has been transformative for everyone.

PV: We have a 600-bed institution and experience a lot of boarding. If we absorbed the exact same volumes moved out over seven days a week, which we’re not planning on doing, we would actually need only 498 beds instead of 600 to take care of that volume, and we wouldn’t have capacity issues. It speaks to how much money we spend as a result of running a hospital system 65 percent of the time while the 35 percent that represents Friday afternoon to Monday morning is just lost.

PS: Also, we drove down our inpatient length of stay dramatically. Over the course of last year, not only were we able to significantly exceed our targets for admissions and discharges, we actually closed 30 inpatient beds. At the early part of last year, we were at about 6.5 days for average length of stay. We finished at about 5.5. And this is at a place that runs at near 100 percent occupancy all the time.

PV: If I understand my hospital economics, a wild guess is that that change in length of stay would be worth about $150 million annually to your hospital.

That was one of the most eye-opening things for the directors when we started coming in on the weekends and we started going floor by floor. You’d see patients here for 120 or 125 days. —Peter Semczuk, DDS, MPH

DE: You started the hallway placement program as a safe option for stable patients, which is a big deal. It plays a huge role over here in getting patients out of the emergency department when there are no beds.

PV: Do you have problems with discharge where it takes a long time to get the orders in and it takes a long time for the nurse to go through it and get them out?

DE: Yes.

PV: I think when you start the discharges in the hallway, the tail would wag the dog. Suddenly, discharge papers would be available.