Date of Graduation

Fall 12-17-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

Carla S. Martin, MSN, RN, CIC, CNL, NEA-BC

Second Advisor

Carla S. Martin, MSN, RN, CIC, CNL, NEA-BC


Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern California. The ELOS team identifies appropriate treatment and disposition options for complex patients across the system with lengths of stays greater than 20 days.

Interventions: Integrating a SNF liaison, as the subject matter expert, into at least 50% of the biweekly ELOS rounds to improve communication and care coordination for patients being discharged to a SNF.

Measures: Primary outcomes include reducing ELOS patient days by 2% (36 days to 35.3 days) during a three-month intervention period from July 2021 to September 2021 and SNF liaison participation in biweekly ELOS rounds at least 50% of the time.

Results: A six percent reduction in ELOS patient days was achieved, and 100% participation by the SNF liaison in attending twice-weekly ELOS rounds.

Conclusions: Reducing LOS in complex patient populations, especially those discharged to a SNF, is achievable when the appropriate specialty care experts are integrated into multidisciplinary LOS rounds.