Though Lehigh Valley Hospital's cardiac service line has received statewide and national recognition for excellence, efforts continue to strengthen and enhance our service. The Cardio Thoracic Length of Stay (CT LOS) Improvement Team was chartered in January, 2005 to improve patient flow and experience. One of the challenges was to create and sustain enthusiasm and engagement for modifying a clinical pathway that had achieved the lowest mortality rates in the state and was ranked nationally for its outcomes. This team was charged with evaluating practices and implementing improvements.

After evaluation, the team focused on cardiac length of stay (LOS), specifically the postoperative CABG surgery period to improve throughput. Goals for the project were to decrease post operative length of stay by 0.5 day by September, 2005 and by 1.0 day by December, 2005 while maintaining outcomes including patient satisfaction and mortality. After review of the current patient flow and identification of key problematic causal relationships, five workgroups were established: OR to Extubation, Post-op Day One, Pre-op/Post-Op Education, Rehabilitation and Role of the Nurse Practitioner. Each workgroup was lead by the relevant discipline.

Outcome:

This team was successful in reducing length of stay from 6.6 days at baseline (FY 04) to 5.17 days for the January - November 2005 timeframe a 1.43 day reduction, well ahead of the established target. The percent of patients being discharged by day 4 increased from 28% to 58% by November, 2005. The percent of patients being extubated within 4 hours has increased from 5% at baseline to an average of 42% through October, 2005 and the percent of patients being extubated within 8 hours has increased from 36% to 70% through October, 2005. Process improvement included revision of existing clinical pathway, increasing Cardiac Rehab inpatient staff and emphasis on ambulation.

Patient satisfaction as measured by Press Ganey was already in the mid 90's for "Likelihood of Recommending" for this patient population, saw a slight increase from a raw score of 94.76 in fiscal year 2004 to 95.4 January to September, 2005. Press Ganey tells us that a one point increase in raw score is statistically significant.