“I am incredibly proud of this team,” says Kari Irwin (seated at center), nursing director of the L2 PRU, of the staff who make up the unit’s new overnight team, which includes (standing from left) Guirlande Sanon, Laurie Dervil, Giselle Chalk and George Fantoni.

Located in the lower levels of the Shapiro Cardiovascular Center, the L2 Procedural Recovery Unit (PRU) cares for patients immediately after they have undergone Cardiac Catheterization Lab (Cath Lab), Electrophysiology (EP) and Interventional Radiology procedures. Although many patients can be safely discharged from the 29-bay patient preparation and recovery area shortly after their procedure, others require additional monitoring and care.

Historically, any patient who needed post-procedure care past 10 p.m. was transported to an inpatient bed in the Shapiro Center. Why? Because until six months ago, the L2 PRU was a daytime unit. But upon seeing an opportunity to help alleviate some of the hospital’s ongoing capacity challenges while ensuring patients receive excellent care, a multidisciplinary team worked together last year to open six beds overnight on L2 PRU for post-procedure recovery patients with less than a 23-hour stay.

Since launching in late August, the L2 PRU has cared for nearly 350 patients overnight who otherwise would have been placed in an inpatient bed in Shapiro.

Kari Irwin, MSN, RN, the unit’s nursing director, spoke with Brigham Bulletin about what these changes have meant for patients, families and staff.

What prompted the decision to open L2 PRU overnight?

Kari Irwin: Some of our cardiology outpatients need to stay for an extended recovery phase, or they just need an extra set of eyes on them overnight. We care for them immediately post-procedure, and before going live with our overnight care, they would typically go up a Shapiro bed.

The capacity challenges have been very difficult, so over the past year and a half, the Brigham leadership team reached out to explore options for providing the same level of care that we would on an inpatient floor in another location.

We want to keep those beds available upstairs for patients who need more extensive inpatient care while ensuring our shorter-stay patients continue to receive great care. As we thought more about it, we realized, who best to care for these patients than the staff who are very familiar with these procedure types? It’s their bread and butter. They know the cases in and out.

How did you put the overnight team together?

Irwin: It was really important that we found a designated team to care for these patients, and that started with a search for two new charge nurses overnight. They cover Monday through Friday, overlapping one day of the week, which is great because we can share ideas and learn from each other. From there, we hired the rest of the team — four nurses and two patient care associates (PCAs). We also have relationship with the Periop Float Pool, which helps support us through sick calls or time off.

Everyone on the team has experience in cardiology or critical care, which was also very important because there’s a spectrum of acuity that we see after patients come out of procedures. Before we opened, I worked very closely with the charge nurses to make sure they had the resources they needed.

It’s been about six months since the overnight service launched. How is it going so far?

Irwin: I am incredibly proud of this team, and they continue to impress me with their care and knowledge. They really just have all the answers. The level and quality of care they provide is no different than any other location in the hospital. We see these patients from when they walk in the door in the morning before their procedure to when they go home, and our team knows them well.

We have capacity for up to six patients right now. That may not seem like a lot, but these patients come out of very complicated procedures and the nurses are working closely with them overnight to facilitate their recovery — getting them to walk and eat earlier, making sure their labs and testing are completed, and ensuring anything else is addressed before discharge.

Have there been notable changes from the patients’ perspective?

Irwin: We changed the culture of the patient care experience. We’ve been able to put a conditional discharge program in place, which is a nurse-driven discharge that allows patients to leave as early as 6 or 7 a.m. if they meet certain clinical criteria.

We found that patients really enjoy knowing they can leave early. They don’t want to wait for their providers to round on them upstairs if that is the only thing keeping them here. We provide them with a to-go breakfast, and most patients and families are happy to get ahead of the morning traffic if they can.

Was there any other memorable aspect of this project for you?

Irwin: When you are part of such a big change like this, there are so many details to consider before going live. One of the great experiences I had was working with all of the different departments to identify and cover all of those needs. It wound up being really fun getting to work with wonderful colleagues in departments like Food Services, Biomedical Engineering and Linen Services — people I never would have had an opportunity to meet if it wasn’t for this project. Everyone came together to make this work.

What do you think that says about the culture of the Brigham?

Irwin: I think that we truly are one big family trying to do the best and right things for our patients. You can tell that the underlying theme is that patients really do come first.