SHM Converge Scientific Abstract ePoster Gallery-Reducing Observation Length of Stay Through Lean Standardization and Workflow Redesign at Overlook Medical Center

Pdf Summary

Overlook Medical Center implemented a Lean, multidisciplinary project to reduce Observation length of stay (LOS), which had averaged 36.1 hours in 2024 and contributed to inefficiency, unit variation, and financial risk. The goal was to reduce average LOS by 10% to 32 hours while maintaining appropriate utilization and quality.<br /><br />A root cause analysis found that prolonged stays were driven by variation in care pathways, Observation patients being spread across nine floors, weekend discharge delays, limited after-hours Utilization Review (UR) and Case Management (CM) coverage, and inconsistent communication among families, physicians, CM, PT, and UR.<br /><br />The team, co-led by the Associate Chief Medical Officer and Director of Hospital Medicine, engaged about 50 hospitalists and interdisciplinary leaders and reviewed 4,500 Observation encounters. Interventions were tested iteratively and included:<br />- Standardized clinical pathways and decision trees for common Observation diagnoses<br />- Geographic cohorting, reducing Observation placement from nine floors to three core units<br />- Expanded UR and CM coverage, including early morning touchpoints and weekend/after-hours support<br />- Education and denial mitigation tools for hospitalists and UR<br />- Standardized ED communication scripting<br />- PT and subacute rehab prioritization for Observation patients<br /><br />Results showed a 4.37% reduction in average Observation LOS (from 36.13 to 34.55 hours) and an 8.47% reduction in median hours (31.48 to 28.82). Extended stays over 90 hours decreased from 4.1% to 2.9%. The core Observation unit sustained about a 2-hour LOS reduction. Importantly, the Observation rate remained stable at 22%, indicating that improvements came from workflow redesign rather than inappropriate inpatient conversion.<br /><br />The project demonstrated that Lean standardization and geographic cohorting can improve reliability and reduce LOS without added resources. Ongoing work will focus on monitoring variation, interdisciplinary huddles, and addressing remaining barriers such as space constraints and testing delays.

Asset Subtitle

Sarah Shihadeh

Meta Tag

Author List Megan Rosenstein, Sarah Shihadeh

Category Research

Concept Observation Care

Concept Length of Stay

Concept Workflow Variation

Concept Clinical Pathway

Concept Hospital Operations

Distinguished Non-Finalist

Presenter Organization Overlook Medical Center

Presenting Author Sarah Shihadeh

Track Quality Improvement

Keywords

Observation length of stay

Lean project

geographic cohorting

utilization review

case management

standardized pathways

hospital medicine

discharge delays

interdisciplinary communication

workflow redesign

Observation Care

Length of Stay

Workflow Variation

Clinical Pathway

Hospital Operations