Clinical Nurse Ladder
Hospital for Special Surgery
Hospital for Special Surgery (HSS), a Magnet Designated and number one nationally ranked orthopedic hospital, sought to provide additional opportunities for nursing growth and advancement. The Capstone team was charged with incorporating evidenced-based practices into HSS’s Clinical Nurse Ladder (CNL) in order to improve the robustness of the system. The team conducted interviews with nurse leaders, carried out surveys to gain perspective from current nurses, evaluated each rung’s (or ladder) job description and remuneration, studied the CNL application process, and examined three other CNLs: New York Presbyterian-Columbia Hospital, Memorial Sloan-Kettering Hospital, and the University of Colorado Hospital. As a result, the team identified the elements of the current and an alternative ladder that were effective/ineffective, and recommended generic but characteristically distinguishable job descriptions for each rung. The team also advised on the role of managers, professional development, and learning in advancing nurses.
Intervening Pre-Admission for Elective Bariatric Surgery
New York-Presbyterian Hospital - Improving Discharge Efficiency
New York-Presbyterian (NYP) strives to ensure that patients are discharged in the safest and timeliest manner possible. When a hospital fails to effectively coordinate discharges, negative outcomes can occur including increases in the length of stay (LOS), costly readmissions, and unsatisfactory patient experiences. The Capstone team’s objective was to identify an elective procedure at NYP with unwarranted variation in LOS between NYP’s campuses and then propose changes to the pre-admission process that could safely decrease LOS. The team conducted a data review and identified significant variation in LOS for elective bariatric surgeries between two campuses of NYP. To determine possible factors for this variation, the team examined the pre-admission processes by conducting site interviews and surveys. As a result, the team identified practices that could be shared to improve the performance of both campuses and recommended using this internal benchmarking process to identify and reduce variations in LOS for other elective procedures at NYP.
Dialysis/Apheresis Operational Excellence Task Force
New York-Presbyterian Hospital - Weill Cornell Dialysis/Apheresis Unit
New York-Presbyterian Hospital (NYP)works to deliver excellent and cost-effective care, while simultaneously facing numerous challenges due to increasingly strict reimbursement criteria, multiple state and federal regulations, as well as stiff market competition within an unstable economic climate. The Capstone team was engaged to develop recommendations to maximize operational efficiency in the NYP Weill Cornell Hemodialysis and Apheresis Unit. The unit faced operational challenges such as shared staff among locations, limited space, staffing mix, variable acuity/census, and inter-dependency upon several hospital departments. The team performed workflow analyses, comparable site visits, staff surveys, reviews of metrics, and consultations with experts and determined that the unit’s treatment turnover time was excessive and above industry benchmarks. This often resulted in increased utilization of overtime and on call. The team made recommendations centered on balanced workflow and efficient utilization of resources in order to reduce treatment turnover time and subsequently generate increased revenue and decreased expenditures.