With inpatient demand stretching hospital capacity thin, UC San Diego Health is taking a collaborative, data-driven approach to proactively refine how patients move through the health system.
Helping lead this effort is Brian Clay, MD, associate chief medical officer of inpatient care and hospital operations. Dr. Clay's role centers on two key areas: improving patient flow — both by reducing length of stay and preventing avoidable extensions — and strategically distributing patient demand across the health system's three hospitals.
Dr. Clay and his team is focused on optimizing patient throughput by enhancing real-time decision-making across teams, minimizing avoidable inpatient days and better allocating resources across the system's network.
Dr. Clay recently spoke with Becker's about this work, outlining several key initiatives the system has rolled out within the past few years to drive capacity improvements.
1. Mission control and daily flow huddles. Last April, Dr. Clay said the health system opened a small "mission control" unit made possible by the Joan & Irwin Jacobs Center for Health Innovation. The unit serves as a coordinated command center for managing inpatient capacity, flow and hospital operations. The team, consisting of four to six key personnel, identifies bottlenecks, expedites discharges and improves bed utilization systemwide. Alongside Dr. Clay, the unit comprises stakeholders from the system's transfer center, nursing supervisor team, imaging services and environmental service teams, among other areas.
The mission control team leads a daily patient flow huddle via Zoom every morning, bringing together senior managers and directors from all three campuses, including emergency departments, intensive care units, perioperative settings, nursing, case management, facility and emergency management services. The huddles offer real-time updates on bed availability and patient flow constraints across the system.
"Everyone shares the state of things and what their needs are," Dr. Clay said. "How many moms are going home on the postpartum floor? Does EVS need to deploy an additional resource because they're going to have to turn over 10 beds in two hours?"
By facilitating these real-time discussions, the mission control team not only addresses immediate operational needs — like bed turnover and environmental services — but also tackles larger systemwide challenges, such as optimizing patient transfers across campuses to balance capacity.
Dr. Clay emphasized that patient flow must be a shared responsibility across the system, rather than falling solely on certain stakeholders.
"Everyone's got a stake in patient flow," he said. "Everyone has a stake in making sure patients are moving through the system as efficiently as possible. Wherever you can hardwire processes to improve flow and make them transparent to everyone who's involved, that makes things work better and you can build on successes."
2. Estimated discharge dates. Beyond daily huddles, Dr. Clay said the mission control team also reviews patients at risk of extended stays every day and works to resolve bottlenecks, such as outstanding procedures or imaging needs, to support timely discharges.
To support this work, UC San Diego Health integrated estimated discharge dates into patient charts about 18 months ago in a discrete, trackable way, allowing for analytics, reporting and dashboard integration.
A key component of this initiative, according to Dr. Clay, was the introduction of a structured documentation workflow for physicians, who are not traditionally trained to consider logistical discharge planning in their notes. To address this gap, the system developed a streamlined documentation tool embedded in the EHR, prompting physicians to estimate the number of days a patient would remain hospitalized and identify outstanding needs. This quick, structured input — taking only about 15 seconds to complete — feeds into dashboards accessible to nurses, case managers and house supervisors, allowing them to prioritize patient flow efforts.
"Having a good sense of when your patients are expected to leave, to be discharged, is really key," Dr. Clay said. "I've been attending here in hospital medicine for over 20 years, and it's only very recently that we've had that information. To a physician out on the front line taking care of hospitalized patients, it's so opaque about how any of this works. That EDD and all of the workflows are the first step toward transparency."
Dr. Clay said that, while EDD accuracy remains a work in progress — currently at 25% to 35% across hospitals — the system continues refining workflows and leveraging real-time data to improve prediction accuracy and expedite patient transitions.
3. Secure messaging and escalations. To further support timely discharges, UC San Diego Health has integrated secure messaging and real-time escalation processes systemwide.
This allows front-line providers, case managers and charge nurses to flag patients ready for discharge but awaiting a key test, procedure or consult — most commonly MRIs, echocardiograms or interventional radiology procedures, according to Dr. Clay. Over the last nine months, more than 400 such escalation requests have been made, with more than half completed the same day. Another 20% were scheduled on or before the estimated discharge date and 10% were converted to outpatient appointments, allowing earlier discharge without waiting for inpatient imaging.
When the system first rolled out its messaging channel a few years ago, Dr. Clay said the majority of messages were inbound from front-line staff. Now, up to half of messages come from mission control team members, who are proactively monitoring patients nearing their estimated discharge dates and flagging opportunities for front-line team members to expedite care to ensure they can be discharged on time.
"We watch the dashboards in the EHRs, identify the patients who are supposed to leave today or tomorrow, see what outstanding needs they have and work to close those throughout the day," Dr. Clay said.
4. Balancing patient demands in the ED. UC San Diego Health is also working to improve ED capacity and better distribute patient demands among its three campuses.
In late 2023, UC San Diego Health acquired Alvarado Hospital Medical Center from Ontario, Calif.-based Prime Healthcare. Since then, the system has been working to steer more patients to the 302-bed community hospital, now known as UC San Diego Health East Campus Medical Center, to relieve pressure on its two main campuses. Initially, the hospital focused on adding necessary beds and staff to increase capacity. Over the past 14 months, this campus' daily average census has increased by about 40 patients, according to Dr. Clay.
Now, Dr. Clay said the hospital is focused on standardizing patient transfers, setting clearer expectations that certain conditions will be treated at specific locations to reduce ED boarding times. To support this effort, Mission Control and the transfer center work closely with emergency providers to route patients efficiently and minimize handoffs, with two-thirds of transfers now occurring before admission rather than post-admission. Additionally, real-time data on bed availability across the system is shared daily, helping ED teams make informed decisions about where to direct patients.
The payoff
Taken together, these efforts — from mission control and estimated discharge dates to secure messaging and ED capacity balancing — have allowed UC San Diego Health to maintain efficiency despite increasing patient demand and acuity.
"Across the enterprise, year over year, for several years, our case-mix index and volume has been going up, but we've held the line on length of stay," Dr. Clay said. "In the setting of increasing acuity and volume, I consider length of stay not going up a win."