Not Too Long, Not Too Short: Getting Hospital Stays “Just Right”

I have a little problem—everywhere I go, I tend to see similarities and parallels to the work we are doing at GBMC. I’m working on it. Let me give you an example.

Breakfast is my favorite meal of the day—there is nothing like a good omelet, a hot cup of coffee, and the company of one of my kids. We go to this fantastic breakfast place, and every time, I see the similarities between my omelet experience and our patients' experience at GBMC. It all points to PATIENT THROUGHPUT!

Hear me out here. Does anyone have the experience of knowing you will have the next table, but something gets in the way? The busboy/busgirl is having a busy day and clearing the dishes from your future table a little slower than your hunger would like... Or worse yet, the people sitting at your future table have paid but keep hanging out longer than you’d expect. The struggle is real, and my kids can spot these delays a mile away!

To operate efficiently, a good restaurant must have excellent processes, communication, teamwork, and the ability to stretch/help another area that is struggling.

You know where else these traits are important? That is right… hospitals, except the stakes are much higher.

Published literature suggests that longer inpatient stays are associated with higher risks of complications, mortality, and readmissions. Furthermore, when the inpatient beds are filled too long, it can negatively impact how our Emergency Department  (ED) operates—like delays in time-sensitive care, lower patient satisfaction, and higher rates of adverse events, particularly for our sickest patients. Therefore, it is critical we get this right.

We have to find the Goldilocks moment (not too soon and not too late) for discharge. Discharge a patient too soon, and they will need to be readmitted back to the hospital. Discharge a patient too late, and the risk of complications rise & it impacts ED operations. Our responsibility is to find that “just right” moment safely, consistently, and with patients and families fully in the loop.

Why I’m talking about this now (in plain English) 
This isn’t just a GBMC challenge...it’s a Maryland challenge. Maryland has struggled with longer Emergency Department (ED) stays compared with the rest of the country for a long time. A statewide HSCRC report notes that Maryland ED length of stay has exceeded national averages for more than 20 years.

Here’s the part most people don’t see: ED waiting is often caused by the hospital being “stuck” upstream. When discharge depends on arranging the next step—support services at home or a specialized recovery setting—things can slow down. Those care transitions are a well-recognized contributor to longer inpatient stays, tighter bed availability, more boarding, and longer waits.  

What GBMC is doing about it 
At GBMC, we are hyper-focused on getting this right—because our patients deserve better than waiting, and our teams deserve systems that work. We have launched two strategic improvement efforts using our Lean Management System: Optimizing inpatient length of stay and improving ED flow.  

This isn’t about rushing. It’s about respect: respecting patients' time, reducing avoidable risk, and making sure that when someone comes to us for help, the system moves with purpose.  

What I’m asking of all of us
As this work accelerates, the principle is simple: identify barriers earlier, communicate clearly, and remove avoidable delays—without compromising safety. When something feels “stuck,” call it out early. When a handoff needs clarity, ask for it. When a barrier repeats, elevate it so we can fix the system (not just work around it).  

Because just like that breakfast table... when the flow gets stuck, everyone feels it.  

Throughput isn’t an operations word. It’s a patient experience word. It’s safety. It’s dignity. It’s the difference between waiting and being cared for. 

Employee Spotlight

Sydney Janowski, BSN, RN, RNC-MNN

RN4

Mother/Baby, Unit 26

How long have you been at GBMC HealthCare?

10 years and 7 months

What is one key way you support a zero harm/safety culture?

One key way I support a zero harm/safety culture as an RN4 on the mother-baby unit is by creating an environment where staff feel empowered to speak up and escalate concerns without fear. I encourage nurses to report near misses and safety concerns through STAR reporting, always reinforcing that the tool is for learning/system improvement rather than being punitive. Another way is by rounding on patients and families to proactively identify any safety concerns, ensure education is understood, and address any issues that may arise. I always promote transparency and help to coach nurses in real time, which helps to ensure both mothers and newborns are receiving safe, high-quality care.

What is the most rewarding part of your job?

The most rewarding part of my job on the mother-baby unit is growing alongside the unit and working with such an amazing staff. Having worked here for 10 years - as a volunteer, unit secretary, nurse support tech, new grad RN, and now as an RN4, I have built such a deep connection to the unit and to GBMC. Each role has shaped me, and in many ways, this unit feels like home. I absolutely love caring for moms and babies during such a pivotal and vulnerable time in their lives. What makes it even more meaningful is that I have been able to grow with the unit. I've seen changes in practice, workflow, new team members come on board, and seasoned nurses mentor the new nurses. Now I have the privilege of being a mentor, supporting new staff through orientation, and watching them develop into strong, compassionate nurses, which is incredibly fulfilling. I take pride in helping the unit run smoothly, being a reliable resource, and advocating for both patients and staff. Working on this unit for so long has allowed me to build great relationships and truly invest in the unit's success. I will be forever grateful for this unit, the staff, and how it has shaped my entire nursing career.

What is your favorite food?

Italian