Acting Like a System: Maximizing Inpatient Capacity Through Operational Integration

Montefiore Health System—comprising a central hub of three academic hospitals and eight affiliated campuses—faced a significant challenge: rising demand for inpatient psychiatric care, limited bed capacity, prolonged emergency department boarding and fragmented workflows across its network. With only 77 dedicated psychiatric beds systemwide, patients in acute psychiatric crisis were experiencing emergency room stays exceeding 45 hours. This situation reflected a broader issue facing many large health systems: decentralized operations that hinder patient flow, strain front-line staff and compromise quality of care. In response, Montefiore launched a bold initiative to reframe its operations around the principle of "acting like a system."

This session will detail the development and implementation of an innovative, data-driven approach to optimizing bed utilization across a multi-hospital network—without relying on capital expansion. Key strategies included: Daily cross-campus, physician-led huddles using real-time data to coordinate bed placement decisions across emergency departments, inpatient medical units and psychiatric units. Systemwide bed stewardship, redefining beds as a shared resource, promoting equitable access and reducing internal competition between hospitals. Standardizing workflows and communication channels to reduce variation and eliminate administrative bottlenecks from admission to placement. Rotating leadership and shared accountability to reinforce buy-in and sustainability across disciplines and campuses. Emergency departments and inpatient medical floors have been highly engaged and supportive partners in this effort. Their collaboration has been critical to driving real-time decision-making and reducing the burden of prolonged psychiatric boarding. By streamlining the transfer of patients to the right care setting at the right time, the initiative has directly improved quality of care, shortened length of stay in ED and medical units, and alleviated strain on clinical teams. These efforts led to a >40% increase in psychiatric inpatient discharges in 2024 vs. 2023. Encouraged by this success, Montefiore has since organically expanded the initiative to incorporate additional system hospitals in the daily huddle process, with campuses voluntarily joining to both offer capacity and seek placement assistance—underscoring a cultural shift toward shared responsibility and true system integration.