Nurse-Led Initiatives Improve Cardiac Care at California Hospitals

Nov 09, 2023

Added to Collection

Participants in the second AACN CSI Academy cohort supported by Edwards Lifesciences Foundation demonstrate improvements in cardiac-focused clinical and professional outcomes

ALISO VIEJO, Calif. - Nov. 09, 2023 – Teams of nurses at seven Southern California hospitals recently reported significant clinical and operational results from their efforts to address some of the most pressing issues affecting their cardiac surgery patients and their units.

The teams of progressive care and critical care nurses were educated and empowered to initiate change, demonstrating measurable improvements to everyday processes and documenting the impact on patient, nurse and hospital outcomes.

The results stem from the nurses' participation in a yearlong, hospital-based nurse leadership and innovation program offered by the American Association of Critical-Care Nurses (AACN).

AACN Clinical Scene Investigator (CSI) Academy is a team-oriented program that builds additional skills for direct care nurses and leverages their expertise, preparing and supporting them as clinician leaders who effect positive changes that improve patient, nurse and hospital outcomes. Nationwide, more than 512 nurses at 104 hospitals have completed the program since its launch in 2012. In total, the program has touched more than 1.27 million patients and more than 7,200 nurses, with an estimated positive fiscal impact to hospitals of nearly $112 million.

AACN provided the program free of charge to the hospitals, thanks to a $100,000 grant from Edwards Lifesciences Foundation as part of the Foundation's philanthropic initiative Every Heartbeat Matters. Cardiac surgery critical care and/or progressive care units selected for the Edwards-supported program were required to care for a significant proportion of patients from underserved*/underrepresented populations in Southern California. The geographic proximity between the hospitals enabled a hybrid approach to learning, combining in-person workshops with web-based sessions.

"CSI Academy continues to demonstrate that nurses are key to improving care delivery and patient outcomes," said Dana Woods, AACN CEO. "Our ongoing partnership with Edwards Lifesciences Foundation allows us to bring AACN's high-impact program to more nurses and patients in under-resourced communities than we could on our own. Edwards's generous funding plays a vital role in ensuring CSI Academy is equitable, diverse and inclusive."

During the 12-month Southern California program, eight teams of nurses at the seven hospitals identified high-priority issues affecting their units and then developed, implemented and evaluated solutions. Participating hospitals were:

  • Cedars-Sinai Medical Center, Los Angeles: (1) Nurses in the cardiac surgical intensive care unit (ICU) created a standardized handoff routine focused on safety checks, reducing post-handoff discrepancies from 73.6% to 25.5%. In addition, zero medication errors have been reported since October 2022. (2) A stepdown unit also participated in the program, and its progressive care nurses decreased unassisted patient falls 50% for patients recovering from cardiac surgery.
  • Loma Linda University Children's Hospital: The pediatric cardiothoracic ICU created a standardized discharge teaching toolkit specific to families' health literacy needs, contributing to a 30% decrease in the 30-day hospital readmission rate. Health literacy is now assessed upon admission for nearly all surgical patients.
  • Loma Linda University Medical Center: Nurses in the cardiac progressive care unit created materials to educate patients with a coronary artery bypass graft prior to their discharge, decreasing readmission rates.
  • Los Angeles General Medical Center: The cardiothoracic ICU reduced nurse turnover from 27% to 19%, below the national average, with a noticeable improvement in staff morale, nurse quality indicators and collaboration with the multidisciplinary team.
  • Providence Saint John's Health Center, Santa Monica: ICU nurses designed a project that improved outcomes for patients recovering from open heart surgery and also raised nurse satisfaction. The Cardiac Care Map has become integrated into the ICU's workflow.
  • UCI Health, Orange: Nurses in the cardiovascular surgical stepdown unit eliminated superficial surgical site infections (from four to zero) by developing educational materials for patients about how to prevent these infections following discharge.

In addition to improving patient and nurse outcomes, the Edwards Lifesciences Foundation CSI Academy teams documented a total anticipated positive annual fiscal impact of $1 million and a median return of 571%.

More teams of nurses who care for underserved critically ill cardiac patients are currently participating in AACN CSI Academy, free of charge thanks to another grant from Edwards Lifesciences Foundation. The nine participating hospitals in this third cohort are in New Jersey and New York. They are:

  • Good Samaritan University Hospital, West Islip, New York
  • Lenox Hill Hospital, New York City
  • NewYork-Presbyterian/Columbia University Irving Medical Center, New York City
  • Newark Beth Israel Medical Center, New Jersey
  • North Shore University Hospital, Manhasset, New York
  • Rochester General Hospital, New York
  • Saint Peter's Hospital, Albany, New York
  • South Shore University Hospital, Bayside, New York
  • Stony Brook University Hospital, New York

AACN offers online access to its collection of CSI Academy innovation projects ― including project plans, clinical interventions, data collection tools, outcomes and references ― as part of the program's goal to inspire and empower as many acute, progressive and critical care nurses as possible. With over 115,000 unique downloads of project materials, the CSI innovation project library has become a resource for hospitals, healthcare administrators and clinical leaders seeking solutions that improve outcomes and reduce costs.

To learn more about bringing AACN CSI Academy to your hospital or health system, complete the request form on the CSI Academy webpage.

*Edwards Lifesciences Foundation identifies underserved people as "… those who have a health disparity as defined by the U.S. Department of Health and Human Services, and lack awareness of, or access to, medically appropriate healthcare." (Every Heartbeat Matters webpage, 2023)

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization's vision is to create a healthcare system driven by the needs of patients and their families where acute and critical care nurses make their optimal contribution. AACN is the world's largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000;;;