Mass General Brigham Care Teams Work Together to Reduce Length of Stay

Mass General Brigham’s Patient Care Progression initiative launched last year with the goal of reducing inpatient length of stay to improve access and quality of care for our patients. Our care teams are leading this work and producing positive results – recent data show an encouraging downward trend in length of stay across our academic medical centers (AMCs) and community hospitals. 

At Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH), the observed-to-expected length of stay metric improved each month from July through the end of 2024, resulting in a 9% overall reduction during this period. 

Observed-to-expected length of stay is the validated metric used by healthcare systems across the country to benchmark their performance. The metric divides a patient’s actual length of stay (“observed”) by the "expected" length of stay, which accounts for their acuity and complexity. The lower a patient’s observed length of stay is relative to their expected length of stay, the better a hospital is performing. The 9% reduction over the second half of 2024 was driven by a rise in expected length of stay and, since October, a drop in observed length of stay.  

This improvement has brought our AMCs to the median of our peer organizations across the country. Previously, MGH and BWH had an observed-to-expected length of stay that was almost 10% higher than comparable organizations, placing them in the bottom tier of their national peer group. 

Similar progress has been made across five of our community hospitals, including Brigham and Women’s Faulkner Hospital, Cooley Dickinson Hospital, Newton-Wellesley Hospital, Salem Hospital and Wentworth-Douglass Hospital. Observed-to-expected length of stay collectively fell by 11% for these organizations in 2024.

“Teams across our system and locally within each hospital have been working together to build solutions that enable us to operate more efficiently and enhance the quality of care for our patients,” said Kyan Safavi, MD, MBA, senior medical director of Clinical Integration and Operations for Mass General Brigham. He and Vice President of Operations Niki Keefe, RN, MSN, MBA, are coordinating systemwide Patient Care Progression work and supporting the multi-faceted collaboration of our care teams.  

“We are moving in the right direction, but we still have substantial room to improve on behalf of our patients,” Safavi said. “Together, we will continue to focus on reducing our observed length of stay, which most directly benefits our patients through higher quality outcomes and greater access to much needed hospital beds.”

Shorter length of stay positively impacts quality both for the patients who leave the hospital sooner – as they experience fewer care delays and reduce their exposure to the risks of hospitalization such as delirium and infections – and for the patients who more rapidly gain access to hospital beds and spend less time boarding in the emergency department.  

Our Patient Care Progression initiative is aiming to eliminate systemic barriers that contribute to delays. Two multidisciplinary teams with dedicated areas of focus – Clinical Progression and Care Transitions & Post-Acute Access – are advancing Patient Care Progression improvement efforts. Colleagues from across Mass General Brigham are collaborating on best practices and innovations within each of the 15 workstreams that these teams encompass.  

Length-of-stay reduction is also a key component of our systemwide work to become a High Reliability Organization (HRO). Every unit participating in HRO unit-based quality rounds is provided with weekly length-of-stay metrics, targets for their unit and tools for each staff member (provider, nurse, and case manager) that can be used to support patient progression. During huddles, staff can identify challenges related to patient progression, share ideas for improvement and then help operationalize proposed solutions.  

“It’s remarkable that across our system, there are so many examples of best practices and innovations that have proven impactful,” Keefe said. “Coming together, we are learning from one another and seeing what is possible. That’s what makes us excited about our path forward as we continue this essential work and achieve further progress.”