“You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.” – Maya Angelou
My daughter recently took a backpacking trip with school, hiking the High Divide – Seven Lakes Basin Loop. This route has a calculated difficulty of hard… 19 miles roundtrip, with 4,000 feet elevation gain in exchange for views of Mount Olympus. While the mom in me held my breath, she went on the trip that she chose and proved to herself that she can do just about anything she puts her mind to. Her exact words about Day 2 of the 4-day trip were “I seriously thought I was gonna die, but then I just kept walking. It was so difficult that you just had to keep going… like stopping didn’t make sense.”
Much of our work to close 2026 and begin 2027 has felt—and will likely continue to feel—this way (minus the teenage overdramatization). Some days may feel like defeat, but defeat is only temporary and we can and will come out of it. After steady improvements earlier this year, September and October are shaping up to be a challenge… we are now in the uphill climb to finish the year strong.
1) Losing Ground with Length of Stay – September 2026 was a challenging month… we feel it when length of stay backslides resulting in fewer discharges, increased boarding in our Emergency Department and leading to Code Surge for throughput. September 2026 LOS was a half-day higher than 2025 at PSPH (5.42 days vs. 4.96 days) and October is trending in the same direction (5.5 days vs. 5.03 days in 2025). Additionally, we have ground to make up due to missing target earlier in the year to reach our target of 5.09 ALOS for the year at PSPH and 4.88 overall for South Puget Sound. Kudos to the team at Centralia for remaining below target… despite an increase in ALOS for September there they remain below target and are trending downward for October to date.
See October LOS data below.
a. Early Progressive Mobility – Our Nursing and Therapy teams are leading the way to ensure our patients stay mobile on admission. EPM scoring within 24 hours and a focus on maintaining and improving mobility improve LOS by half a day on average, by avoiding deconditioning and helping patients get ready for a discharge home when possible. You can help this work by ensuring EVERY patient has activity/mobility orders.
b. Setting the Medically Ready Date (MRD) within 36 hours of admission – when a MRD is entered within 36 hours of admission it improves LOS by a half day on average, by helping our teams coordinate care around when the patient will be medically ready for discharge.
c. Planning for Discharge on Admission – Some of our patients and families are waiting until their medical condition is sorted out to make decisions about where they will discharge to. When plans change, unnecessary days are tacked on to their hospitalization. Planning for discharge from admission and having a Plan B helps avoid extra days.
d. Why not Home, Why not Today? – Returning home is a great option for many of our patients and our Care Management teams can help connect our patients and families to resources in our community for assistance. For some, discharge to a skilled nursing facility isn’t an option due to finances, denial, or other factors out of our control; denials and no plan B also lead to additional days. Our patients going to SNF often stay TWICE as long as anticipated… coordination and avoiding unnecessary days here REALLY matters!
