Patients are more concerned about accessing care than the time they spend receiving it. In the survey, patients ranked ease of admission as more important (39%) to the overall care experience than ease of discharge (25%). Though crucial for overall efficiency, patients rank short wait times for physicians (15%) and diagnostic testing (17%) among the least important contributors to the overall care experience, highlighting patient focus on front-end access and relatively little emphasis on wait times during the stay itself. Patients also ranked delays in receiving information (21%), long waits before being admitted (20%), and difficulty getting help when needed (18%) ahead of long discharge wait times (11%) as reasons they wouldn’t recommend or return to a hospital.

Percent of respondents selecting each factor as a reason to not recommend or return

Q: Which of the following aspects from your care experience would make you not recommend this provider or return to this hospital/health system?

Patients perceive delays as stemming from operational rather than clinical issues. Patients identified waiting for paperwork or admission orders (24%) and waiting for a bed to be cleaned or prepared (22%) as the most common causes of admission delays, followed by no bed being available (17%) and transportation delays (15%). Among delayed bed moves, 70% are tied to bed cleaning. Patients also view discharge delays as non-clinical in nature, identifying discharge paperwork as the primary reason patients wait to leave the hospital (65%).

The access and efficient admission that patients value is the product of whole-system flow. Although patients can easily identify delays at the front door, many of the factors driving those delays originate elsewhere in the hospital. Delayed discharges, bottlenecks in testing or consults, and bed turnover challenges all reduce capacity for incoming patients. Patients may not see the work required to improve throughput, reduce length of stay, or accelerate discharges, but they experience the results through faster access to care. Improving patient access therefore requires a whole-system approach that addresses barriers across the care journey rather than optimizing individual departments in isolation.

Improving access requires addressing the operational barriers that limit capacity across the hospital. Here are two strategies that can help organizations free up inpatient capacity and improve patient flow across the care journey.

Strategy 1: Streamline steps across the care journey. Many of the delays patients experience are rooted in breakdowns during transfers and bed management. Improving visibility into patient progression and assigning ownership for each step can reduce bottlenecks throughout the system.

• Centralized flow management: Command center models provide real-time visibility into patient location, discharge readiness, transfer status, and operational bottlenecks across the organization. By centralizing flow management, hospitals can move beyond department-level optimization and coordinate decisions across the system, improving patient movement from admission through discharge.

Strategy 2: Shift from first come, first served to prioritized flow. Traditional workflows often move patients through the system based on queue order rather than overall impact on patient flow. Prioritization strategies help organizations address barriers that are preventing discharge and creating upstream bottlenecks.

• Prioritization logic: Testing, consults, and other care activities should be prioritized based on clinical urgency, expected discharge timing, and overall impact on throughput rather than solely on order of arrival. This approach helps remove barriers for patients who are closest to discharge while improving flow across the organization.
• Reverse rounding: Traditional physician rounding often prioritizes patients by clinical acuity, leaving discharge-ready patients later in the workflow. When clinically appropriate, reverse rounding flips that sequence. By prioritizing patients expected to leave the hospital, teams can confirm readiness and address discharge barriers earlier in the day. Treating discharges as planned events rather than day-of decisions accelerates bed turnover, creating capacity for admissions, transfers, and bed placement across the system.

Diagnostic testing and discharge planning are opportunity areas where coordination beyond the inpatient visit can improve operational efficiency.

In hospital settings, there is a default bias toward overtesting and a long-standing "when in doubt, admit" mentality. While mainly well-intentioned, this kind of defensive medicine can contribute to overtreatment by extending hospital stays and consuming capacity, without meaningfully improving patient outcomes. Patients can also contribute to this dynamic, often expecting a “do everything while admitted” approach. New advisors, including social media and AI chatbots, can also contribute to this issue by influencing the treatments patients ask for, even when they're not medically necessary.

At the other end of the care journey, many patients remain hospitalized while post-discharge services or follow-up arrangements are finalized. Hospitals become a holding environment when there are challenges or discharge delays, especially for patients who can’t go home. More than one in five patients (21%) have a non-routine discharge, with many leaving the hospital for another care setting rather than returning home, underscoring the importance of coordinating care across multiple settings.

Stronger continuity of care beyond the hospital stay can reduce avoidable admissions, preserve capacity, and ensure patients receive care in the most appropriate setting. Though, hospital-based care has long been treated as the default, causing leaders to overlook gains that could be made by moving away from this care model. Historically, limited outpatient access has further reinforced overreliance on inpatient care. However, things are shifting. Health system leaders report increasing capital expenditures on new ambulatory facilities, while spending on new inpatient facilities has fallen significantly over the past three years.¹ With fewer organizations expanding inpatient capacity, leaders increasingly need to create capacity within existing hospitals by reducing unnecessary utilization and ensuring patients receive care in the most appropriate setting.

Still, clinicians in the inpatient space often feel a lack of influence when it comes to coordinating with ambulatory and post-acute care providers. They also risk negatively impacting patient satisfaction by deferring care during a hospital stay. To support appropriate use of alternative care settings, organizations must strengthen coordination across the care continuum so clinicians can confidently refer and discharge patients.

Some opportunities to improve operational efficiency lie outside the inpatient stay. Reducing unnecessary admissions requires stronger coordination across the continuum and clearer pathways to care.

Strategy 1: Strengthen coordination across the care continuum. Patients often remain in the hospital while waiting for discharge arrangements or tests and follow-up services that could be delivered in alternative sites of care.^5,6 Better alignment across inpatient, outpatient, and post-acute settings can reduce unnecessary hospital days without disrupting patient care.

• Extend coordination beyond discharge: Effective discharge planning goes beyond clinical instructions to include patient education, expectation setting, scheduling assistance, and transportation coordination. These steps help patients navigate the transition to the next level of care and reduce post-discharge disruptions. Use of discharge lounges can further enhance throughput by freeing inpatient beds while administrative tasks are finalized, without patients feeling rushed.

Strategy 2: Create alternatives to unnecessary admission. According to our survey, many admissions are driven by monitoring needs (41%), additional testing (36%), or unresolved symptoms (31%). These are often situations where faster diagnostic decision-making can prevent unnecessary inpatient stays.

• Real-time review of inpatient diagnostic testing: Organizations should regularly evaluate inpatient testing orders to identify opportunities to move nonurgent services to outpatient settings. Conducting these reviews in real time, rather than after the fact, can help prevent unnecessary hospital days while increasing capacity in diagnostic service lines. This often requires a centralized team or role with visibility into orders, queues, and patient status to make live prioritization decisions.
• Observation management pathways: Organizations should establish clear inpatient-versus-observation criteria, defined decision timelines, and prioritized diagnostics for patients whose status remains uncertain. The goal is to reach an admission or discharge decision as quickly and safely as possible rather than defaulting to a full inpatient stay.

Strategy 3: Design systems that support appropriate utilization. Reducing avoidable admissions requires addressing contributing behaviors and assumptions.

• Standardized care protocols: Well-designed pathways and workflows can reduce variation in decision-making and help limit defensive medicine behaviors that contribute to unnecessary testing and admissions. Protocols should be specific, measurable, and reinforced through incentives and performance expectations.
• Reframe efficiency as better care: Longer stays don’t always lead to better outcomes. Patients and clinicians should understand that reducing non-value-added time in the hospital can improve safety, lower costs, and preserve capacity for patients who need acute care most. With 85% of respondents indicating they have a primary care provider, clinicians can use primary care visits and other touchpoints to educate patients on seeking care in the most appropriate, cost-effective setting. Efficient care is not about immediacy or convenience. It is care delivered in the right setting, at the right time, for the right reason.

¹ Nives M, Wiles E, et al. Survey insights: The 5 trends redefining health system strategy in 2026. Advisory Board. June 8, 2026.

² Shrank WH, Rogstad TL, et al. Waste in the US health care system: estimated costs and potential for savings. JAMA. October 7, 2019

³ Site-of-care shifts: Healthcare’s $50B opportunity. Advisory Board. June 6, 2024.

⁴ Hospital Expenses per Adjusted Inpatient Day (2024). KFF. Accessed July 29, 2026.

⁵ Milligan C, Teicher B. New AHA Report Finds Delays in Ability to Discharge Patients Increase Strain on Patients and Hospitals. American Hospital Association. December 6, 2022.

⁶ Robinson NB, Gao M, et al. Secondary review reduced inpatient MRI orders and avoidable hospital days. Clinical Imaging. November 19, 2021.