Cleveland Clinic's Cardiac Surgery Initiative Reduces Length of Stay

To care for Cardiovascular Surgery patients as they recovered postoperatively, nurse clinicians on Cleveland Clinic's G80 Unit used to spend their shifts running between floors and calling surgeons to coordinate patients' treatment plans. This wasted both time and energy, and as a result, nurses couldn't always give their full attention to patients, some of whom have cases so complex that they've been turned down by other hospitals.

To resolve these issues, Cardiac Surgery recently piloted a new caregiving approach on Unit G80, in which post-operative treatment is coordinated by nurse practitioners. As part of the new approach, Cardiac Surgery reorganized its coverage areas into zones, including G80, where each surgeon's patients are placed together. In less than a year, this approach has improved efficiency in Cardiac Surgery, shortened length of stay and allowed nurses to develop better relationships with their patients.

Nurse practitioners take the lead
One of the issues the G80 team needed to resolve was the inefficiency of patient care. "There were a lot of providers taking care of these patients, and length of stay was above national benchmarks," says Gina Cronin, Administrator, Thoracic and Cardiovascular Surgery.

Prior to the pilot, surgeons and cardiologists managed their patients' postoperative care plans, which were carried out by surgical nurse clinicians, cardiology nurse clinicians, residents and hospitalists. This system worked well until a patient went into atrial fibrillation or another situation arose in which a decision regarding the patient's care needed to be made quickly.

"The challenge for us was, 'Who do we call for what?'" says Nurse Manager Jackie Spence, RN. "There were a lot more hands in the pot." Often, the patient's surgeon would be called from the operating room for guidance.

To streamline the process, each patient's care plan now is managed by a nurse practitioner, who meet with surgeons early in the morning and again after the last surgery to share updates on the 10 to 12 patients whose care they oversee.
"One of us is always there," says Nurse Practitioner Kathryn Piccolo, CNP, "and that really makes it consistent for the patients and their families."

New zone coverage
During the pilot, the team met with Patient Transportation and other departments to find out how to place a surgeon's patients in one location, or zone. At first, this seemed impossible, says Cardiac Surgeon Joseph Sabik, M.D. "It took a lot of change in the way of thinking," he explains. "But the reason it worked is that a lot of people were involved in it. It really is a group effort."

The zone coverage allows bedside nurses to work closely with nurse practitioners and, when issues arise, they can quickly proceed with the patient's treatment. "A lot of times, they [bedside nurses] will come to us with general questions, too," says Piccolo. "So I think we're also there as an education resource."

Better care, shorter length of stay
When they began the pilot project, the G80 team expected that it would improve its efficiency and also boost patients' satisfaction and it accomplished both. However, it also led to a dramatic drop in the department's opportunity days.

Due to its success, G80's caregiving model will be rolled out in all of Cleveland Clinic's Cardiac Surgery units by the end of 2008. Since nurse practitioners will be in demand to lead the new model, scholarships were created to allow Cardiac Surgery's nurse clinicians to return to school to become nurse practitioners.