Tahoe Forest nursing report: surgical volume up, Press Ganey scores rise, AI pilot and staffing initiatives planned

Nursing and operations leaders at Tahoe Forest Health System reported higher surgical volumes, improved patient-satisfaction metrics and a series of operational changes and pilot programs during the board meeting.

Jan, speaking for nursing leadership, said the system’s surgical service area grew 13.7 percent in 2024 and that the perioperative governance changes — including a Perioperative Governance Council established after Optum consulting — helped increase operating-room efficiency. “We've had a busy OR,” Jan said. The organization also is using its off-site surgery center to relieve pressure on the main hospital OR and to expand access for some routine specialties.

Jan reported a notable lift in inpatient Press Ganey scores: inpatient moved toward the 95th percentile and the aggregate system score rose to about 96.25. Jan credited staff-model adjustments on med-surg units and related process changes for that improvement.

Nursing leadership described several workforce and community programs:

• A high-school shadowing/volunteer program now operating in Incline with Washoe County Schools is being expanded to Truckee High; the program is intended to introduce seniors to careers across the health system. Jan said participation is limited to students vetted by school counselors.

• Community health advocates (sometimes referenced as promotoras) have been integrated with the care coordination team to streamline referrals and better align services for patients, especially for clinic- and admission-related needs.

• Tahoe Forest will increase planned hospitalist coverage for admissions at the Incline facility so admitted patients can be managed locally; staff said hospitalists will initiate orders remotely and see patients within 24 hours.

• For neonatal transfers, Tahoe Forest has a transfer agreement with Mercy San Juan in Sacramento to provide an additional referral pathway for babies needing NICU-level care; staff noted UC Davis and Renown are other regional partners used depending on capacity and insurance.

• The district’s extended-care/skilled nursing unit (ECC) plans to expand skilled rehab capacity from four to seven beds once two hires (a PT and OT) are completed; staff said they expect to reach seven skilled beds in February.

On donation and quality processes, nursing leadership explained the system must notify Sierra Donor Services within one hour of a death for tissue-donation referrals as part of accreditation requirements; the facility reported six tissue donors during the past year and occasional delays in meeting the one-hour notification target when bedside staff were occupied.

Radiology and trauma standards were addressed: the American College of Surgeons standard requiring final reads within 12 hours prompted the district to add radiologist coverage through about 9 p.m. daily so exams read overnight meet the 12-hour window, staff said.

Operational and technology pilots include an Epic (Mercy) pilot to generate AI-based end-of-shift nursing notes. Nursing leaders said the district volunteered as a pilot site and will provide real-time feedback to Mercy to address accuracy concerns before broader adoption.

Finance and revenue work: Jenny Parvin, the district’s revenue-integrity RN, is leading a revenue-integrity program with consulting from Moss Adams to create denials-management processes, charge capture and chargemaster compliance. Finance leadership called the program “new” and said it will take time to build measurable denials reductions.

Other operational items discussed included a new IV catheter rollout in February, integration of OR housekeeping staff into the surgical service to improve communications, expanded neonatal respiratory training supported by UC Davis, and preliminary work toward primary stroke certification led by Dr. Abby Young and coordinator Julie Morgan.

Most items reported by nursing leadership were for board discussion; no formal board action was required at the meeting on these operational changes.