Nurse-Driven Post-RPATH Collaboration to Improve Outcomes and Efficiency in the CVICU

Authors: Angelika Stachura, MSN, RN, CCRN, CNL; Emily Selby, BSN, RN, CCRN; Lillian Hall, MSN, APRN, ACCNS-AG, CCRN-K; and Kathleen Posa-Kearney, MSN, APRN, ACCNS-AG, CCRN

After several years of planning, the RPATH transition of 11 East and 10 West’s patient populations occurred in September 2020. The change in patient population and the presence of a new provider team introduced unique challenges for the Cardiovascular Intensive Care Unit (CVICU) staff, requiring an extensive overhaul of workflows and practices. Nursing staff and ICU leadership collaborated with multiple disciplines and teams to remove operational barriers and improve patient care, quality and safety.

Clinical nurses voiced concerns to leadership at a town hall with the chief nursing officer and chief medical officer regarding workflow, patient throughput issues and patient safety concerns. In response, 11E leadership created an interdisciplinary committee in December 2020 called the Cardiosciences Collaborative that meets monthly to address staff concerns, create action plans and evaluate current and new workflows. The team consists of cardiovascular surgery, cardiology and heart failure attendings; lead advanced practice providers; executive nursing and medical leadership; 11E leadership; and staff nurses.

The Cardiosciences Collaborative has thus far devised several initiatives to improve workflows and patient outcomes. The goals are to address patient assignment issues, improve interdisciplinary collaboration, maximize nursing participation in rounds, improve patient care, maximize critical care bed capacity, standardize workflows to promote consistent patient management and address staff knowledge gaps about the new patient population. The following initiatives have been implemented to address these goals:

  • Collaborated with the Emergency Department and Patient Placement to create algorithms for patient admission
  • Ordered dedicated phones for each cardiac team and designed communication guidelines
  • Created a process with cardiac medicine to include bedside nurses in rounds and maximize nurse participation
  • Constructed a workflow to place orders for patient care and transfers to ensure efficient transitions to lower levels of care
  • Developed and implemented a monthly orientation for cardiac providers
  • Initiated the Critical Care Lecture Series where guest speakers present monthly on relevant ICU topics

Post-RPATH Cardiosciences Collaborative Quality Improvement Data