Date of Graduation

Summer 8-9-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Liesel Buchner

Abstract

Abstract

Problem: Prolonged LOS in the PACU for patients undergoing total joint replacement surgery contributes to inefficiencies in patient flow, delayed throughput, and increased resource utilization. At Hospital A, recent LOS averages exceed internal and regional benchmarks, indicating a need for process improvement.

Context: The PACU is a high-volume, fast-paced environment requiring coordination among nursing, physical therapy, anesthesia, and discharge planning teams. Variability in workflow, communication gaps, and inconsistent timing of key processes contribute to delays in discharge readiness.

Interventions: From May through July 31st, 2026, a quality improvement project was implemented using the Baldrige Excellence Framework and the Institute for Healthcare Improvement Model for Improvement. Interventions included initiating discharge education upon caregiver arrival, standardizing postoperative cefazolin redosing four hours after the initial intraoperative dose through an updated order set, and improving interdisciplinary communication regarding patient readiness for physical therapy.

Measures: The primary outcome measure was PACU LOS in minutes. Process measures included the timeliness of antibiotic administration, initiation of discharge education, and standardization of communication regarding physical therapy readiness.

Results: Average PACU LOS decreased from 318 minutes to 296 minutes, representing a 6.9% reduction. Although the predefined goal of a 10% reduction was not achieved, the project resulted in measurable improvement in PACU LOS while successfully implementing standardized perioperative workflows that enhanced interdisciplinary communication and reduced variation in care processes.

Conclusions: Standardizing perioperative care processes established a sustainable framework for delivering consistent, evidence-based care to total joint replacement patients. While additional work is needed to achieve the desired reduction in PACU LOS, the project demonstrated the value of structured quality improvement methods and interdisciplinary collaboration in improving workflow efficiency and supporting continued performance improvement.

Keywords: PACU length of stay, total joint replacement, quality improvement, Model for Improvement, Baldrige Framework, interdisciplinary collaboration.

 

 

Download

Share

COinS