Jesus Reverol, administrative director of performance improvement at University Medical Center of El Paso
Photo: Jesus Reverol
University Medical Center of El Paso is the only Level 1 trauma center within a 270-mile radius and the region's only Level 1 stroke center and Joint Commission-certified comprehensive stroke center.
THE CHALLENGE
UMC El Paso launched a length of stay improvement initiative in March 2023 and continued to build on that foundation into 2025 with additional operational and care delivery improvements. These efforts followed a baseline review conducted from October 2022 through February 2023.
That review showed an average length of stay of 5.99 days and approximately 1,357 admissions per month.
Extended stays were creating emergency department bottlenecks, delaying discharges and limiting access for new patients who needed care. These pressures were building across the health system and, without a plan to address them, becoming increasingly difficult to manage.
"Coming out of COVID, we also saw a sustained rise in patient acuity that never really normalized," said Jesus Reverol, administrative director of performance improvement at UMC El Paso. "Patients were sicker, required more complex care and, as a result, were staying longer in the hospital. That longer length of stay created a ripple effect.
"Beds were not turning over quickly enough, and patients who needed to be admitted were spending extended hours boarding in the ED," he continued. "What had once been a manageable range of boarding hours escalated significantly, and it began to impact not just operations but the overall patient experience."
The emergency department is often a reflection of what is happening across a hospital. When boarding hours rise, it's not just an ED problem – it's a signal that something upstream, particularly around discharges and inpatient flow, is not working as efficiently as it should, he added.
"We realized that patients who were clinically ready to move to the next level of care were waiting longer – not because of clinical delays but because of operational friction," he explained. "From a patient perspective, the impact was real. Even with strong clinical care in the ED, it's just not designed to be a long-term care environment. Patients were spending extended time on stretchers in cramped rooms instead of in appropriate inpatient settings – affecting comfort, family experience and the overall sequencing of care."
PROPOSAL
The shift UMC El Paso needed to make was not just about adding tools – it was about fundamentally changing how we used data to manage the hospital in real time, Reverol said.
"Historically, we were looking at key metrics like length of stay retrospectively, often at the end of the month," he noted. "By the time we identified a variance, it was already too late to influence performance. The proposal from our team was to re-evaluate how we used information systems from TeleTracking – which we've been using for a number of years – to move to a real-time, data-driven operating model.
"At the core of this approach was visibility," he said. "TeleTracking was able to provide critical operational data around patient flow – including admissions, discharges, bed status and pending discharges – that we could then merge with additional insights like month-to-date length of stay and performance against our internal targets."
Instead of asking what happened last month, the technology was designed to let UMC El Paso staff start asking where they are today and what they need to do before tomorrow. The belief was that the approach would create a much tighter feedback loop between performance and action.
"Equally important was the idea of connecting data to accountability," Reverol said. "By making performance visible, not just to leadership but eventually to physicians and frontline teams, we created a shared understanding of how daily decisions impacted system-wide outcomes.
"The expectation was that with real-time dashboards, structured daily reviews and leadership engagement, we could identify barriers earlier, intervene faster and ultimately smooth patient flow across the entire hospital – reducing pressure on the ED and improving access for the community," he added.
MEETING THE CHALLENGE
The real impact came from how staff embedded these dashboards into daily and weekly workflows across the organization.
"This isn't a passive reporting exercise," Reverol explained. "It became an active management system. On a daily basis, leadership teams reviewed discharge reports generated through the data the vendor made available, focusing on volume, timing and trends.
"At the same time, we monitored a month-to-date length of stay dashboard built internally, which became one of the first metrics reviewed each morning," he continued. "If we see performance drifting from target, we have the data necessary to act immediately through direct follow-ups, operational adjustments or escalation during clinical rounds."
The technology is used by multiple layers of the organization, each with a specific role. The executive leaders – including the COO, CNO and CMO – are actively engaged in weekly performance reviews, where dashboards inform both day-to-day improvements and strategic decisions including opportunities for new pilot programs aimed at improving throughput.
Operational leaders and throughput teams actively monitor daily metrics and are now able to raise flags when intervention is needed. Frontline physicians and nurses have also been brought into the process with the availability of performance dashboards that show the length of stay for their patient populations relative to benchmarks and peers, creating both awareness and accountability.
"Even at the unit level, tools like the pending discharge feature in TeleTracking help teams anticipate next-day discharges and proactively remove barriers," Reverol said. "Integration was less about technical systems and more about workflow alignment.
"The data served as the backbone for real-time operational awareness, particularly around bed management and discharge planning, while internal dashboards complemented with broader performance analytics," he continued. "Together, they created a unified view of the hospital that we just didn't have before."
This has allowed staff to implement targeted initiatives – including weekend service expansion, ancillary staffing adjustments and structured interdisciplinary rounds – with confidence they could measure impact quickly and refine in real time, he added.
RESULTS
One of the most meaningful outcomes has been the reduction in inpatient length of stay – from 5.99 days at baseline to 5.29 days in the most recent fiscal year.
"This improvement was not driven by a single initiative, but by the cumulative effect of real-time visibility and coordinated action," Reverol explained. "By using dashboards to track performance daily, we were able to intervene in real time rather than waiting until the end of the month.
"That meant we could preserve monthly performance by identifying trends early and deploying targeted solutions, whether that was reinforcing discharge planning practices or addressing bottlenecks across the care continuum," he continued. "A critical component of this was the intentional effort to become a true seven-day-a-week hospital."
By expanding Sunday procedures and diagnostics and rightsizing ancillary services such as echo and ultrasound, staff reduced the backlog of cases that would typically accumulate over the weekend and delay care progression on Monday mornings. The result was not just a lower length of stay but a more responsive health system that continuously corrects itself, he added.
"Another critical metric was ED boarding, which we reduced by more than half, from 17,500 hours to 8,100," he reported. "This is where the connection between data and operations became most visible. By closely monitoring daily discharges and understanding their downstream impact, we were able to smooth variability and prevent the spikes that lead to boarding.
"The combination of TeleTracking real-time flow dashboards and updates to our workflows allowed us to anticipate pressure before it materialized," he continued. "Instead of reacting to overcrowding, we began preventing it. The expansion of weekend services and improved turnaround times in ancillary areas also played a direct role here, ensuring patients continued to progress through care without unnecessary delays."
UMC El Paso also saw significant gains in observation length of stay, reducing it by 20% from 42 to 34 hours.
"A key driver here was the introduction of the ED Transitional Clinic, launched in late 2024, which diverted more than 800 patients from unnecessary observation stays," he explained. "The dashboards helped us identify which patients could be safely redirected and ensured follow-up was coordinated at the clinic site.
"This is an example of how the new data we started using does not just optimize existing processes but enables us to consider and ultimately institute entirely new care pathways that improve efficiency without compromising care," he concluded.
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