New Knowledge, Innovation & Improvements

Los Gatos Emergency Department nurses with Wall-E
Los Gatos Emergency Department nurses with Wall E: (back row, from left) Jonathan Ruth, RN; Mark Garvey, RN; Jeremy Bruce, RN; (front row, from left) Lilian Wu, RN and Meriam Signo, RN

A New Robot for Los Gatos

The Los Gatos Emergency Department (ED) focused on overall length of stay and worked on a number of initiatives to decrease time to admission and discharge from the ED. In March 2019, recognizing that patient diagnoses, treatment and disposition were often delayed while awaiting lab results, Pamela Fiehmann, manager of the ED, formed a team of clinical nurses to help solve the issue of lab turnaround time in the ED, related to delays in specimen transport.

The team explored several options, such as adding FTEs and installing a tube system, however, these options were not feasible.

Meriam Signo, director of Nursing Services Los Gatos, suggested a Relay® robot, which was purchased and implemented in March 2019 to transport specimens from ED to lab.

A naming contest was held, and the new robot's name is Wall E. Nurse champions helped teach staff how to use the robot, which has helped decrease the ED length of stay by 15%.

Food as Medicine in the Cardiac & Pulmonary Wellness Center (CPWC)

In 2018, Julee Arbuckle, manager of the CPWC, led a multidisciplinary task force that worked on developing a new curriculum for cardiac patients which focused on the importance of food as it relates to heart disease, emphasizing plant-based nutrition. A full time registered dietitian was hired, and she meets with patients to provide assessments, a nutrition plan, advice and even recipes.

The clinical nurses helped develop a new workflow that included nutrition education provided by a CPWC clinical nurse during their intake assessment with the patients. In addition, CPWC nurse Karen Roman began teaching a new course called Stress Matters.

Food as Medicine was implemented in the second quarter of 2018. Outcomes were measured in July 2019, and the average patient weight loss increased by 124%. Scores on the quality of life survey taken by patients increased by 525% in the emotional wellness domain, and by 155% in the general health domain.

CPWC Food as Medicine team
CPWC Food as Medicine team: (from left) Craig Clemens, MA, RCEP, CSCS, CPT; Sheri Berger, RDN; Nanette Malgesini, RN and Julee Arbuckle, BSN, RN, CCRP

Expan the Geriatirc Resource Nurse Program
El Camino Health Cancer Center nurses (from left): Diego Rodriguez, RN; Nancy Vick, RN; Theresa Shen, RN and Dan Garza, RN

Decreasing Late Medications in the Cancer Center

In early 2019, Cancer Center patients experienced significant delays in medication administration. Delays were so significant that some patients required second doses of their pre-medication because the effects had worn off before they received chemotherapy. Some patients could not receive their medications in the clinic because of the delays, and were admitted to Short Stay for their infusions. Diego Rodriguez, manager of the Cancer Center, and Theresa Shea, nursing unit coordinator, reviewed the issue and determined that workflow between Cancer Center and Pharmacy created the issues, and created an improvement plan.

By changing the process of sending the full list of patients and ordered medications for the day to Pharmacy all at once, to sending the orders just prior to each patient's arrival, the average time from patient arrival to time of medication administration decreased 68%.

This improvement led to increased patient satisfaction and improved morale among the nurses.

Cancer center patient arrival to medication graph