Abstract
Purpose and Objectives:A quality improvement project was conducted to create a sustainable continuum of care for increased volumes of outpatients receiving percutaneous coronary interventions. Dramatic growth exposed system vulnerabilities and left staff overwhelmed. Four postinterventional project objectives included reducing preprocedural preparation times, reducing bleeding complications, reducing hospital length of stay, and collectively increasing patient satisfaction.Description of the Project:Amidst creating a specialized postintervention coronary recovery area and acquiring and training existing preregistration and recovery nurses, a fragmented system of care was united. The clinical nurse specialist–led project used a systematic and evidence-based implementation process to harmoniously acclimate perioperative staff. An evaluation process further defined new opportunities to support a growing service line.Outcomes:Postimplementation data were collected over a 3-month period. An overall improvement was found in all targeted objectives, despite an upsurge in case volumes. A moderately significant correlation (r [105] = 0.424, P < .001) was found between bleeding occurrences and hospital length of stay.Conclusion:The synergy between interdepartmental collaboration and strategic staffing reallocation was shown to be invaluable to alleviate procedural areas of service, such as the cardiac catheterization laboratory. As a project champion, the clinical nurse specialist is an essential catalyst to identify and creatively surmount system-level challenges.
Highlights
The advent of new legal regulations often presents immense opportunities for clinical institutions to begin providing services to patients that were previously limited
There were noticeable improvements observed in all 4 project goals, which were to reduce preprocedural preparation times, reduce the rate of bleeding complications, decrease outpatient percutaneous coronary interventions (PCI) patient hospital length of stay, and increase overall patient satisfaction
The preregistration nurses were already well trained to conduct prehospital patient interviews, the Clinical nurse specialists (CNSs) and unit leadership were instrumental in ensuring that preprocedural PCI patient orders, procedural contraindications, and laboratory instructions were well established and communicated
Summary
The advent of new legal regulations often presents immense opportunities for clinical institutions to begin providing services to patients that were previously limited. California, for example, passed Senate Bill 906, allowing California hospitals without an on-site cardiac surgery program to provide elective PCI, providing they met specific criteria.[7] Beginning in 2015, once hospitals and procedural centers became approved, patients had more potential locations for diagnostic and interventional services. Cardiac catheterization laboratory personnel accustomed to supporting a relatively small number of emergent PCI began to feel the strain of an additional patient load. In the first year alone, diagnostic and interventional volumes doubled as the result of the new elective PCI program.[8] The increased case load exposed a fragmented outpatient system of care in which existing nursing resources could not sustain optimal perioperative care
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