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Case Study

How ESNEFT tracked avoidable inpatient days to eliminate bottlenecks

30 Minute Read


The challenge

Organizations typically use length of stay (LOS) to identify patient flow bottlenecks. But because LOS is impacted by factors other than avoidable care delays, it’s difficult to correctly identify bottlenecks with the greatest impact on system-wide flow.

The organization

East Suffolk and North Essex NHS Foundation Trust (ESNEFT) is a public health system based in Colchester, England. It operates two large acute care facilities, several community hospitals, and primary care services.

The approach

ESNEFT’s red and green day initiative has increased efficient patient throughput, resulting in major cost savings for the system.

The results

ESNEFT used their red and green day data to develop several initiatives that addressed their most impactful bottlenecks. Most significantly, these initiatives reduced delayed transfers of care by 41% after one year of implementation.



How ESNEFT tracked avoidable inpatient daysto eliminate bottlenecks 

ESNEFT pioneered the “Red2Green” process for identifying and addressing avoidable acute care delays. This process has since been adopted by organizations around the world. This publication details the components of the Red2Green process.


The three components

There are three components to implementing the Red2Green process:

  • Component

    Define patient days as red or green

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  • Component

    Tag each red day with the reason care was delayed

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  • Component

    Use red day metrics to drive system-wide patient flow strategy

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Centralized approach decreases inefficiencies, costs

ESNEFT achieved significant improvements to operational efficiency, including delayed transfers and stranded patients (the UK term for patients who remain in the hospital for seven or more days after they were deemed medically ready for discharge). These improvements translated into major cost savings for the system.


Reduction in delayed transfers of care one year after implementation


Decrease in stranded patients one year after


          Savings in Cost Improvement Programmes

In 2016, ESNEFT’s Red2Green process won the 2016 Health Service Journal’s award for acute care innovation. It’s since been adapted by many other hospitals within the UK and beyond.

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