# A trust-wide quality improvement programme to reduce out-of-area placements, length of stay and costs across inpatient mental health services

## TL;DR

A UK mental health trust successfully reduced out-of-area patient placements and shortened hospital stays through a comprehensive quality improvement program.

## Contribution

A trust-wide program combining step-up beds, crisis housing, and data-driven management significantly improved mental health inpatient flow and reduced costs.

## Key findings

- Out-of-area placements dropped 93%, saving £8.5 million.
- Average length of stay decreased by 17.5%.
- Trust-wide bed occupancy fell from 106% to 92%.

## Abstract

•Step-up/step-down beds, crisis house and robust triage linked to better flow outcomes.•Bed routines and flow teams support faster transitions and system response.•Locally tailored interventions enhance engagement and sustainability.•Standardising core principles helped deliver consistent outcomes.•Leadership, partnerships, data and daily management drove effective flow.

Step-up/step-down beds, crisis house and robust triage linked to better flow outcomes.

Bed routines and flow teams support faster transitions and system response.

Locally tailored interventions enhance engagement and sustainability.

Standardising core principles helped deliver consistent outcomes.

Leadership, partnerships, data and daily management drove effective flow.

In the UK, rising demand for inpatient mental healthcare and fewer beds has led to persistently high occupancy, delayed admission and increased out-of-area placements. Consequently, only the most complex cases are admitted, contributing to longer lengths of stay.

Between April 2024 and March 2025 East London NHS Foundation Trust ran a trust-wide, large-scale quality improvement programme across all geographical directorates, to eliminate out-of-area placements and reduce length of stay. The programme followed a structured improvement approach; directorates moved stepwise from identifying a quality issue through to implementing change ideas that resulted in improvement through testing.

Out-of-area placements reduced 93%, (from 66.5 to 4.6 per week), avoiding £8.5 million in costs. Average length of stay on London adult mental health wards fell by 17.5%, (53 to 43.9 days). Trust-wide bed occupancy decreased from 106% to 92%, and service users clinically ready for discharge reduced by 51%, (111 to 55 per week).

Tailored interventions, real-time data, leadership and collaboration drove impact. Future work will focus on sustaining gains and enhancing community alternatives.