patient centred care: a journey through cardiac surgery › assets › hospitals › ... · patient...
TRANSCRIPT
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Patient Centred Care: A Journey Through Cardiac
Surgery
A collaborative Edmonton Zone Cardiac Sciences Program Endeavour.
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Cardiac Rehabilitation Prior to Cardiac Surgery
Kara Penney, RN, BN
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WhoWhatWhy
• Waiting for CABG surgery is a reality in the Canadian Health Care System
• The mortality rate for patients awaiting CABG has been shown to be remarkably stable (0.5 to 0.6%)
• HOWEVER evidence shows that patients’ functional and psychological status can deteriorate while waiting for surgery
Arthur et al, Annals of Internal Medicine. 2000. 133(4).
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WhoWhatWhy
• Patients report being fearful of participating in physical activity while waiting CABG surgery
• Poor physical fitness preoperatively is associated with increased length of hospitalization
Sawatzy et al. Clinical Rehabilitation. 2014. 28 (7).
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# Scheduled CABG Patients on the Waitlist
Current Wait Time (weeks)
# of Admissions while waiting Surgery
December 2014 51 Cath to Surgery 20.2 • Approximately 5% of
scheduled patients changed from Scheduled to Semi-Urgent or Urgent Status2014 Calendar Year 338 RTT to Surgery 11.6
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• Improvement in functional capacity
• Increased adherence to rehabilitation program components
• Decreased anxiety
• Link with post-op CABG pts
• Decreased admission and readmission rate
• Decreased length of stay
• Reduced post-operative complications
PURPOSE & RATIONALE
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1. Patient Meets Referral Criteria2. Referral is faxed to CR Program3. Intake Nurse Reviews Referral 4. Intake Nurse Contacts Patient 5. First Appointment6. Patient Undergoes ATP7. Results reviewed by Team 8. Patient starts tailored program 9. Home Maintenance10. 3 Month ATP11. CABG Surgery12. Enters Cardiac Surgery Cardiac
Rehab after Surgery
PR
OC
ESS
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The PREHAB MAHI – Pattison Study(PRE-operative Rehabilitation for Reduction of
Hospitalization after Coronary Bypass and Surgery in Alberta)
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What’s Next?
• Increase referral rates• Tours of the Mazankowski• PAC• SCN collaboration • Evaluation• Telehealth to in-patients
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Cardiology Semi-Urgent Pre-Op Package
Presenter: Lisa Marco, RN
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Improve the Semi-Urgent Patient
Experience Transition to Surgery.
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What is a Semi-Urgent Patient?
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Patient experiences an acute cardiac episode
Patient is admitted to the Cardiology Unit
Patient is stabilized
Patient/Physicians discuss and agree to surgery
Patient is discharged home to wait for surgery
Patient is admitted by Same Day Admitting for surgery
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Improving the Experience
Patient Centred….
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A group of dedicated
stakeholders developed the Semi-Urgent
Patient Package.
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Through a collaborative process several resources were created for patients and the health care team.
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For Health
Care Providers
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For Patients
and Family
• Patient Resource Checklist
• Shower and Skin Prep Guidelines
• Information on Endocarditis
• Information on Chest Binders and Brassieres
• Personal Directive Information
• Eating and Drinking before Surgery
• Information on Sternal Precautions
• Cardiac Surgery Discharge Planning Assessment
• Recovery After Heart Surgery
• Accommodation List
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We look forward to your questions and suggestions for improvement.
Thank you.
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Booking the OR Collaboratively
Tara Peters, RN
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The Cardiovascular Surgery Process Improvement Team Identified an Opportunity…
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A group of stakeholders agreed to try a new approach to book the CV Surgery OR Slate.
Very Important
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In January 2013 the OR
Collaborative Booking Team
was created.
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The OR Collaborative
Booking Team Includes
• Nurse Navigators• CVICU Unit Managers• Surgeon Administrative Assistants• Cardiac OR Manager• Cardiac Sciences Zone Manager
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To optimize OR utilization and reduce postponements, the team meets weekly to plan the next week’s slate.
We discuss and adjust the draft slate to plan for complex cases and potential unplanned emergencies,
enhancing patient flow.
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Did the change result in
Improvement?
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Surgical Postponements 2012
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Surgical Postponements 2013
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“I’ve really noticed a difference in the flow of the CVICU over the last year. Previously the unit would become back logged with a large number of high acuity patients. Now, discharges from the unit seem to occur more evenly. And as a result ORs don’t seem to be postponed as frequently.”
Qualitative Feedback
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Lessons Learned and Subsequent
Improvements
• To accommodate urgent inpatients and emergent patients, the slate is not booked to full capacity
• Helps the Pediatric patient transition to the Adult Program with increased ease
• Massaging the slate moves complex cases to the week’s end
• Enhances ability to proactively plan the patient transition home
• The team has enhanced awareness of patient context:
o Case Complexityo Past Health History & Co-Morbiditieso Family Dynamics & Social Issueso “Red Flags”
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CCC PosterPresentation
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Thank you.
We look forward to your feedback and questions.
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Transitioning Home after Cardiac Surgery
Laurianne Gamache-Pearl, RN
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Role of the Cardiac
Transition Nurse
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Identified a gap to bridge
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There was an opportunity to smooth the patient transition home.
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Important Team Member
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Patient and Family Centred….
The Transition Nurse guides the Patient and Family throughout their
Post Operative Care Journey.
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Integral to the Health Care
Team
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What Does the Data Say?
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Home
Repatriation
Sub Acute
Other
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Home Repatriation Sub Acute Other
Percentage 91% 6% 2% 1%
Discharge Location (June 2014 to January 2015)
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330
183
141
91
64
32
28
25
20
18
Glenrose Rehabilitation Hospital
Jim Pattison Centre for Heart Health
Grey Nuns Hospital
Deferred
Red Deer
Grande Prairie
Calgary
Camrose
St. Paul
Fort MacMurray
0 50 100 150 200 250 300 350
Top 10 Cardiac Rehab Referral Locations
Number
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Did a ChangeMake a Difference?
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Improving the Patient Experience
Patient
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Thank you.
We look forward to answering any questions
you have.