At the 2026 ACMA Southern California Chapter Conference, Dr. Diana Tai, Executive Director of Acute Care Services at Orange Coast Medical Center in Fountain Valley, California, delivered an informative, ground-level account of how a 240-bed community hospital cut ED diversion hours from 300 a month to nearly zero. For a hospital with no space left to grow, the only path towards improvement was flowing into more efficient operations.
Orange Coast Medical Center: A Capacity-Constrained Hospital With Nowhere to Grow
Orange Coast Medical Center is part of a three-hospital system that has what Dr. Tai described as a “mom and pop” environment. The facility is physically landlocked with no room to expand, which meant the only place they could grow was in how they operated.
Before a plan was implemented, Orange Coast was averaging over 200 ED diversion hours between January and May of 2023 alone — and by year’s end, that figure had climbed to 300 hours per month. This spike in hours affected nearly 900 patients every month who were subsequently delayed or turned away. Against a backdrop of nearly 50,000 annual ED visits, boarding remained a persistent pain point, discharge planning rounds were inconsistent with roughly three-hour delays, and high Length of Stay (LOS) costs — measured in millions — were consuming resources the hospital desperately needed elsewhere.
Project May Day
In May, Dr. Tai and her team launched Project May Day: a structured, data-driven redesign of how patients moved through Orange Coast from ED arrival to discharge. The initiative brought together Nursing, EVS, Social Work, Infection Prevention, and executive leadership across a series of intensive working sessions to map the current state and design a better one.
The team used an Affinity Diagram approach; writing every identified problem on a post-it note, grouping them by theme, and surfacing the most actionable clusters. What emerged was a focused problem set: bed turnover rate, patient delays, lack of transportation, and poor cross-departmental communication.
Three parallel work streams drove the redesign:
- Work Stream #1: ED Admissions – Who gets a bed and when? Actionable steps included an enhanced huddle structure with EVS, clearer EMR-based visibility into patient status, and standardized communication about transport.
- Work Stream #2: Unit-to-Discharge Transition – What happens once a patient reaches a unit? The team redesigned multidisciplinary rounding to make discharge planning a priority, not an afterthought.
- Work Stream #3: Discharge Execution – How does the team actually get the patient out the door? Focus centered on meeting anticipated discharge dates and closing the gaps between clinical readiness and physical departure.
How Did the Hospital Redesign their Discharge Infrastructure to Improve Flow?
Several structural changes came out of Project May Day. A new Bed Flow Coordinator role was created to sit at the intersection of Nursing and EVS — someone whose job is tracking discharge progress and room readiness in real time. The nursing administration area was redesigned with an “air traffic control” mindset, giving coordinators sightlines across the entire unit in order to improve coordination.
A twice-daily bed board huddle at the beginning and end of the day gave EVS, Social Work, and Infection Prevention a shared operational rhythm. Printed discharge trackers let EVS allocate cleaning resources proactively rather than reactively.
The team also embedded discharge milestones directly into EPIC, creating a real-time checklist of pending actions. When these actions had all be checked off, it was a clear signal that the patient was ready to be discharged. EVS turnaround was tracked through an EPIC EVS module, measuring wait times and dispatching cleaning crews based on data.
The last improvement that was made was was to implement a a discharge lounge. This allowed patients who were awaiting final paperwork or discharge rides could wait comfortably, freeing up the room they previously occupied to begin turnover for the next admission.
Operational Takeaways That Healthcare Leaders Can Learn From Orange Coast
#1: Standardization Is What Makes Operations Scalable
Dr. Tai invoked the 80/20 rule as a guiding principle: if a process works correctly 80% of the time, the 20% variation in success becomes a manageable hiccup rather than a systemic failure. The goal isn’t total operational perfection, it’s consistency. When workflows are standardized across an organization, the cognitive load on frontline staff drops, handoffs become reliable, and accountability becomes possible. Standardization also requires genuine cross-functional buy-in, it doesn’t happen by mandate, it happens through collaboration.
#2: If You Can’t Show the Data, You Can’t Advocate for Change
You must be ready to show your data if you want to advocate for any sort of meaningful change. Orange Coast knew that their pre-change metrics were 300 diversion hours per month and 900 patients affected. Without having those baseline stats, it’s much harder to get broader buy-in — not to mention without knowing where you started, there’s no measure of progress and no proof of impact. As of March 2026, diversion hours sit at 20. Length of stay dropped 30%. The discharge lounge is running at 120 patients per month against a target of 80. Access to this kind of data makes it easier for others to implement more positive change in the future.
#3: A Lack of Transportation Directly Affects Length of Stay
One of the key findings from Project May Day was that the single biggest driver of patient delays wasn’t in the clinical part of care, it was a lack of transportation. Patients were medically cleared, discharge paperwork was done, but the beds were still occupied because transportation hadn’t been arranged.
Orange Coast Memorial took the first step towards eliminating transportation as a barrier by giving their clinical supervisors and Bed Flow Coordinators access to an Uber account to arrange rides for patients who had no other way home. Discharges accelerated, beds turned over faster, and length of stay came down in a way that clinical intervention had struggled to achieve.
#4: Technology Has to Work For the Staff, Not Against It
“Technology is law” was one of Dr. Tai’s closing tenets, but the spirit behind it matters. New technology only creates value when it’s embedded into healthy workflow, not piled onto an existing, struggling system. EPIC’s discharge milestone checklist and the EVS dispatch module both succeeded because they reduced friction rather than adding steps. If the EMR isn’t making nurses’ lives easier, it’s making patients’ experiences worse.
The Solution Was Inside the Hospital All Along
Project May Day didn’t succeed because Orange Coast had more resources than other community hospitals. It succeeded because the team stopped treating throughput as a symptom of capacity constraints and started treating it as a problem worth solving on its own terms.
For healthcare leaders watching their ED volumes climb, their length of stay numbers stagnate, and their staff burn out from workarounds, Orange Coast offers a replicable playbook. Standardize what you can, measure everything identify the barriers and address them directly. Then trust the data to tell you what’s working and what needs more nurturing.
The hospitals with the best throughput aren’t the necessarily the biggest or the best-resourced. They’re the ones that decided to investigate their internal operations and work towards a more efficient solution.
If transportation is one of the barriers standing between your patients and a faster discharge, Roundtrip can help. Schedule a demo to see how reliable access to transportation leads to a more efficient discharge workflow.