Dr. James LaFeir. Photo credit: Benjamin Rusnak
Chest pain. Those two frightening words conjure thoughts of the worst: a heart attack. You rush to the emergency room looking for answers, only to spend days in the hospital undergoing tests to discover what’s wrong, the waiting and uncertainty even more terrifying than the initial pain. But Dr. James LaFeir ’14, a Doctor of Nursing Practice (DNP) graduate, is working to make diagnostic care for chest pain more efficient to improve patient care.
“People were coming in and staying for 2 or 3 days for testing only to be told that everything was negative,” he explains. The patients and the hospital staff were all frustrated, and LaFeir knew there had to be a better way. He wanted to tackle the issue both through his role as a clinical specialist at Broward Health Medical Center in Fort Lauderdale, Florida, and through his doctoral study.
LaFeir didn’t want it to be just an academic exercise, so he helped the hospital launch a pilot program using nurse practitioners in a dedicated clinic to evaluate chest-pain patients for heart disease. The goals? Reduce the average 2.5-day stay to less than 24 hours, reduce re-admissions, and increase patient satisfaction and education with dedicated staff to confirm those negative test results or diagnoses more quickly.
The program was a huge success. Within 30 days of implementation, the length of stay for these patients dropped to between 26 and 27 hours; now, it’s between 24 and 25 hours.
“Patients seem a lot happier,” LaFeir says. “They’re sent home with education, needed medication, and a follow-up appointment if they don’t require emergency care, rather than sitting around waiting for answers. Our re-admission rate has dropped 6.6% because now they have follow-up care.”
The results were so impressive that Broward Health is expanding LaFeir’s chest-pain program to include a new pilot program for heart-failure patients. This will involve advanced technologies to help with the safe removal of those patients presenting with fluid overload in chronic heart failure.
“That’s the spirit of what this DNP program is all about, translating your scholarly project into an actionable impact,” says Dr. Faisal Aboul-Enein, DNP program faculty member and one of LaFeir’s doctoral study committee members. “His work was the first I’ve seen that made positive change at a unit level and now has gone even further. It’s had community impact, and that speaks volumes.”
Dr. Daniel Berman, doctoral study chair, notes that LaFeir’s project addressed the two hottest national issues in healthcare: improving quality of care while decreasing cost and increasing access for underserved people.
“Jim is doing this to create real change,” Berman says. “This project has not only improved healthcare but also addresses the needs of vulnerable populations—such as non-U.S. citizens without health insurance— in Southeastern Florida.”
The opportunity to implement real change at his hospital is what motivated LaFeir to pursue his doctorate after more than 40 years in nursing. He had heard great things about Walden from fellow nurses, and he loved the flexibility to study on his own schedule.
Now LaFeir serves as a preceptor for other Broward employees who are pursuing their DNP at Walden. “I like teaching and motivating people to be better,” he says of being a preceptor. “To me, that’s the ultimate sense of accomplishment.”