The 7-Day Care Model: Preparing for the Future of Patient Access

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EP LAB DIGEST. 2025;25(4):1,11-12.

Jennifer Graham, MSN, RN, NE-BC, CPHQ, Director of Electrophysiology; Joshua Peltz, MBA, MSN, RN, FACHE; Erin Frazier Roaché, MHA, RN, NE-BC; Mogregory Morgan, BAS, AAS, RT(R); Elizabeth Rogers, MHA, BSN, RN, CV-BC; Bill Viar, BSRT, RCP

Sanger Heart & Vascular Institute, Charlotte, North Carolina 

Many of us know the feeling: Monday morning arrives, and the list of electrophysiology (EP) inpatients has piled up. Outpatients are urgently awaiting procedures, and it feels like the entire week will be an uphill battle. How can we continue to best improve access to care and reduce inpatient length of stay? Faced with limitations in space and staffing, our EP lab decided to approach this challenge by embracing the journey toward a 7-day care model.

EP is poised for significant growth in the coming years. The prevalence of atrial fibrillation in the United States is near 3.9%, with fewer than 5% of these patients receiving ablations.¹ Early ablation offers not only improved clinical outcomes but also enhanced patient quality of life.² Without the willingness to explore creative solutions, we risk being unable to meet the growing demand for care. 

Advocate Health, the third-largest nonprofit integrated health system in the United States—created from the combination of Advocate Aurora Health and Atrium Health, is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Atrium Health Carolinas Medical Center, our flagship hospital in the Charlotte market, has embarked on a journey to implement a 7-day care model for outpatient procedures. Currently underway, this expansion will help shorten wait times for procedures while also allowing us to effectively care for inpatients and decrease length of stay, freeing up hospital capacity. In the article, we detail implementation of this 7-day care model approach.

The Vision for a 7-Day Model

The traditional 5-day care model used in most EP labs has proven inadequate in addressing our increasing patient volumes and demand for timely care. There is a ripple effect from this model, leading to extended wait times, late evenings, providers frustrated with limited access, and staff burnout. This strain extends beyond the lab to the ambulatory space, where staff manage care for increasingly frustrated outpatients waiting extended periods of time for procedural care.
Our team identified barriers to procedure capacity growth: time, space, and personnel. While plans for additional lab space are in progress, they are not a solution available today. To expand our ability to care for the growing population, we recognized the need to adopt a new operating model that extends beyond the traditional workweek.
 
Building the Foundation

Before proceeding with a 7-day model, our team conducted a comprehensive assessment of patient needs, staff availability, and operational logistics. This included an assessment of standard operations and identifying gaps that may exist, as resources on weekends are often reduced. Seamless collaboration and elimination of silos were key to the success in developing this initiative.

The first step was to gain leadership support. We presented a clear business case to administrative and nursing inpatient leaders, emphasizing the benefits of increased access to care, patient satisfaction, and shorter inpatient length of stay. These goals resonated with leadership, and we were able to gain buy-in readily. Even with this support, we needed to address barriers to ensure that procedural care could be safely delivered on weekends. 

Leadership scheduled joint meetings with key departments, including surgery, patient registration, inpatient units, patient transport, security, prep and recovery, lab, imaging, and anesthesia. These meetings helped align goals and address potential challenges and workflow needs before go-live.

Staffing and Resource Management

In addition to cross-functional collaboration, the success of the pilot phase depended on creative staffing strategies. Our lab staff and prep and recovery team supported the pilot phase by offering lucrative incentives and staffing strictly on a voluntary basis. This allowed us to evaluate improvements in access to care without prematurely committing to long-term staffing adjustments.

To create a sustainable long-term staffing plan, clinical and administrative leaders collaborated to develop strategies for a sustainable staffing model. Managers recognized that staff input would be vital to adoption and engaged their teams in discussions to identify unique solutions tailored to each area. Strategies discussed included adjusting staff allocation to support 7-day coverage, exploring part-time and per-diem staffing, and allowing teammates to move into newly created shifts. These proposals, approved by leadership, reflect a collective effort to support growth while addressing staff needs.
 
Preparing for Go-Live

Staffing was only one of the operational items on leadership’s to-do list. The focus remained on maintaining the same high standards of care patients receive during weekday operations. This required cross-departmental alignment and frequent communication. Staff in prep and recovery and in the lab needed to understand the workflows for each department, which in many cases differ from weekday workflows.

A failure mode and effects analysis (FMEA) was performed to identify possible failures in processes, including the management of procedural emergencies. This allowed us to mitigate situations that had the potential for complications or unfavorable outcomes. Clear guidelines for procedures were developed, identifying “no-go” cases that require full weekday support due to complexity, to eliminate the most severe complications during times when resources were diminished. This focus on safety was paramount to staff, who voiced greater comfort with the expansion knowing guardrails were in place.
 
Overcoming Challenges

The journey toward this model has not been without obstacles. While the potential benefits are clear, implementing this model requires thoughtful problem-solving and adaptive leadership to address unique challenges.
One of the most significant challenges has been ensuring adequate staffing across all involved departments, including patient registration, anesthesia, imaging, and lab services. Weekend staffing often relies on leaner teams, creating pressure on those who volunteered to support the pilot phase. Collaborative planning with department leaders helped mitigate these challenges and minimize disruption.

Despite the voluntary shifts worked in our pilot phase, leadership remained mindful of the potential for burnout and fatigue among staff. This was proactively managed through a commitment to on-time case completion on weekends, regular check-ins to allow staff to voice concerns, and acknowledgment of staff contributions to the program’s success.

These early challenges underscore the complexity of transitioning to a new model but also highlight our team’s ability to collaborate and adapt, allowing us to overcome barriers and lay the foundation for sustained success.
 
Progress

Our lab has been performing outpatient procedures on select Saturdays since the fourth quarter of 2024. As of mid-January 2025, we have performed 25 Saturday procedures, with a nearly even split between inpatients and outpatients. Inpatients had been waiting an average of 4.5 days for available block time to have their procedures. Their discharge over the weekend or on Mondays has saved approximately 55 bed days. In a time when capacity is strained across the country, this impact is significant.

Outpatient procedures have been limited to sedation procedures, as we have not been able to secure additional resources on all weekend days. However, progress is being made, and as this resource becomes more available, higher-complexity procedures are being scheduled.
 
Lessons Learned

The journey toward a 7-day care model has provided our lab with valuable insights that will shape our approach moving forward.

The most obvious takeaway is the realization that our staff are highly committed to delivering safe care. Their willingness to support this initiative through feedback and staffing affirms the importance of engaging teammates early and often. Staff often have the best understanding of what works—and what does not—in daily operations. Their suggestions were instrumental in refining workflows and identifying barriers. When staff feel safety is a priority, it is easier to embrace change, and shared decision-making yields shared ownership of the program’s success. 

Despite months of planning, resources have not always been available, requiring flexibility and creativity to adapt to unforeseen circumstances. Experienced staff on every shift is essential, especially in the early stages of rollout. Healthy contingency plans helped the team manage unexpected scenarios, including staffing adjustments and call-outs in supporting departments.
 
Conclusion

The pursuit of a 7-day care model has been transformative for our EP lab. While we are not yet at full implementation, the steps we have taken demonstrate that significant improvements in access to care are achievable through strategic planning and teamwork. We have laid the groundwork for sustained success in this new model of care. This initiative underscores the importance of collaboration across departments, the value of staff engagement, and the necessity of flexibility in adapting to challenges.

Health care delivery must evolve to meet growing demands. By embracing creative solutions like a 7-day model, we are improving access to care and positioning ourselves to better serve patients and communities. The lessons learned from this initiative will guide us as we refine our approach, ensuring our lab remains a leader in innovation and excellence in patient care.
 
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. They report no conflicts of interest regarding the content herein.

References

1. Oltman CG, Kim TP, Lee JWY, Lupu JD, Zhu R, Moussa ID. Prevalence, management, and comorbidities of adults with atrial fibrillation in the United States, 2019 to 2023. JACC Adv. 2024;3(11):101330. doi:10.1016/j.jacadv.2024.101330 

2. Rohrer U, Manninger M, Zirlik A, Scherr D. Impact of catheter ablation for atrial fibrillation on quality of life. J Clin Med. 2022;11(15):4541. doi:10.3390/jcm11154541