Date of Conferral
8-11-2026
Date of Award
August 2026
Degree
Doctor of Nursing Practice (DNP)
School
Nursing
Advisor
Cara Krulewitch
Abstract
Inadequate medical-surgical telemetry capacity contributes to emergency department (ED) boarding, patient transfers, decreased patient satisfaction, and operational inefficiencies. This systems-level organizational leadership project evaluated a proposed 10-bed medical-surgical telemetry unit expansion at a medical center in Northern California. The project addressed the question of how a 10-bed expansion would affect ED boarding, patient crossovers to a nearby medical center, patient satisfaction, and financial performance. Trend analysis of occupancy, ED boarding, and crossover data, regional benchmarking, and financial modeling using net present value (NPV) and internal rate of return (IRR) were used to evaluate the proposed expansion. The organization currently operates 42 medical-surgical beds compared with an estimated demand of 66 beds, creating a 24-bed capacity deficit. Medical-surgical occupancy has remained above 92% for 18 consecutive months, and average ED boarding time is 3.5 hours compared with a regional average of 2.3 hours. Without intervention, the capacity deficit is projected to increase to 28 beds by 2033. Financial analysis estimated capital expenditures of $22.12 million and annual operating benefits of approximately $2.5 million, producing an NPV of $21.23 million and an IRR of 23.5%, exceeding the organizational benchmark of 11.0%. The expansion is expected to increase medical-surgical capacity from 42 to 52 beds, reduce ED boarding and patient crossovers, and improve patient experience and access to care. Structured staff education, competency validation, and workforce planning will support safe implementation. The project promotes positive social change by improving equitable access to inpatient services for an underserved community. *Keywords:* medical-surgical telemetry, inpatient capacity, emergency department boarding, patient flow, nursing leadership, healthcare finance
Recommended Citation
Kaur, Sumitpal, "10-Bed Medical-Surgical Telemetry Unit Expansion to address inadequate inpatient capacity" (2026). Walden Dissertations and Doctoral Studies. 20645.
https://scholarworks.waldenu.edu/dissertations/20645
