Decreasing Boarding Times Before and After Cardiac Procedures

Project Topic:

Decreasing the amount of time patients are boarded in the pre and post op area

Hospital, City and State:

The University of Alabama-Birmingham Health System, Birmingham, Alabama

Unit:

• Pre and post unit of the Heart and Vascular Center

CSI Participants:

• Melissa Chambers, BSN, RN
• Mary Johnson, MHQS, RN
• Brittni Jones, BSN, RN
• Marshala Wynn, BSN RN
• Nurse Manager: Mary Jane Hammett, DNP, CNML
• Coaches:
  • Dana Morson, DNP, CRNP, FNP-C, CNE
  • Lin Carter, MSN, RN, CNL (Interim)

Project Goals/Objectives:

1. Decrease total monthly hours of overnight postoperative boarded patients 10%
2. Decrease costs due to overnight boarders 10%
3. Increase aggregate score on the AACN Healthy Work Environment Assessment Tool (HWEAT) from “moderately healthy” to “very healthy”

Project Outcomes:

1. Decrease total monthly hours of overnight postoperative boarded patients 34.5%
2. Decrease costs due to overnight borders 34.5%
3. Increased aggregate score on the AACN Healthy Work Environment Assessment Tool (HWEAT) from 4.38 to 4.43
4. Increased HWEAT aggregate score and 5 of the 6 standards.
5. These outcomes resulted in a positive estimated annual fiscal impact of $24,878

Project Overview:

In today’s increasingly complex healthcare environment, care teams are managing higher-acuity patients who require longer lengths of stay, contributing to sustained high hospital occupancy.

The Heart and Vascular Center operates as a high-volume procedural department, accommodating approximately 88 patients per day. Care delivery includes pre-operative preparation, procedural intervention, and post-procedure recovery, with most patients discharged the same day.

Beginning in 2021, the department experienced a shift in operations due to hospital capacity constraints, requiring selected patients to remain overnight in the pre- and post-operative areas. With only 17 pre-operative rooms available, this created significant operational challenges. The coexistence of overnight patients and scheduled outpatient volume resulted in workflow inefficiencies, staff role adjustments, and increased strain on team coordination.

To address these challenges, the CSI team initiated a structured process to identify barriers to timely patient discharge and reduce the duration of overnight boarding in pre-operative spaces. Key barriers identified included delays in ancillary services and communication gaps across departments.

A primary example involved echocardiograms required prior to discharge. Limited early-morning availability of echocardiography services delayed clinical decision-making and discharge orders. Through cross-departmental collaboration, communication processes were enhanced and staffing schedules were adjusted, enabling earlier service availability and improving patient flow.

The CSI team also prioritized broad engagement and accountability by communicating the initiative across all stakeholders, including nursing staff, advanced practice providers, physicians, and support services. Performance visibility and friendly competition were introduced to encourage timely discharges. Real-time tracking of discharge orders and completion further supported process adherence and accountability.

As a result of these interventions, the team achieved a reduction in boarding time of 42.6 hours when comparing equivalent timeframes year over year. This improvement not only alleviated operational strain on staff but also contributed to an estimated annualized cost savings of $24,878.