The Queen’s Medical Center

Honolulu, Hawaii

Reducing the length of stay for inpatient holds at The Queens Medical Center Emergency Department remains a significant challenge requiring a hospital-wide approach. Surge protocols use ED and inpatient capacity, throughput and acuity to identify overcrowding. It also is used to activate multidisciplinary responses, including expedited transfers, discharges, staffing adjustments and bed optimization. ED leadership and shared governance regularly evaluate barriers and opportunities for improvement. A key initiative revised isolation protocols and implemented a communicable disease screening tool completed within one hour of admission orders. Nurses in the 55-bed ED assumed responsibility for timely completion to reduce unnecessary isolation, improve bed utilization and help decrease boarding times.

Additionally, the Queens Clinically Integrated Physicians Network/Transitional Case Management Program ED discharge pathway, implemented in 2024, strengthens transition of care for high-risk ED patients through an EHR-embedded referral process and nurse-enabled warm handoff. Eligible patients receive telephonic or in-home transitional support within one business day, with follow-up for at least 30 days focused on medications, appointments and community resources. Referrals increased from 65 per month in early 2024 to 155 per month by late 2025. Engaged patients had 30-day readmission rate of 8 percent versus 11 percent system-wide.