Date of Graduation

Summer 8-9-2022

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

Dr. Cathy Coleman



Problem: Inpatient colonoscopies are costly to healthcare systems and inconvenient for eligible patients. The cost for a two-night inpatient bed is currently $4800.00 currently. The department manager led a five-month quality improvement project that was initiated in one 180-bed community medical center in Northern California to increase outpatient options, reduce the census and decrease the admission rate.

Context: Overburdened medical facilities often miss the opportunity to utilize ambulatory procedures due to competing operational priorities. In this setting, the Care Without Delay (CWD) department microsystem addresses barriers that impact operational throughput, efficiency, and unnecessary admissions.

Intervention: A new protocol was developed with a triage process that assisted eligible patients to address barriers such as limited mobility, various levels of dementia, transportation challenges and financial constraints.

Measures: Three relevant measures were formulated. The outcome measure included the percentage of eligible patients that chose to have preparation for an outpatient versus inpatient colonoscopy. The primary process measure was determining the subset of eligible patients compared to all patients scheduled for inpatient colonoscopy. The balancing measures included assessing the total percentage of patients that were eligible but opted not to participate in the new protocol and monitoring the fluctuation in admission rates for colonoscopies.

Results: Ten patients were identified that were appropriate for the new protocol; three patients opted not to participate. The protocol was successful for seven patients resulting in avoidance of fourteen hospitalization days. The return on investment for the project resulted in saving approximately $26,880.00. In addition, unsolicited requests from front-line staff and management of the Gastro-Intestinal (GI) department for participation in the new protocol have continued indicating strong interest in continuous improvement.

Conclusions: Clinical Nurse Leaders need to foster a culture of learning, continuous improvement, and systems-based practice. By focusing on a person-centered approach, attention to front-line operations, team building, and cost avoidance both organizational and patient outcomes can be actualized. The protocol can be replicated in other facilities to aid in admission reduction, increase patient/staff satisfaction and potential injury reduction to staff and patients that are admitted.


Accolades to my dear colleagues in Cohort 10, much love to all of you.