Put CABG patients on a fast track
Risk designates suitability
Physicians and nurses at St. Luke’s Episcopal Hospital and the Texas Heart Institute, both in Houston, expect to save more than $1 million this year by placing selected coronary artery bypass graft (CABG) patients on a fast-track program. Hospitalization costs thus far average 20% less than those of bypass patients in traditional programs.
A comparison of the fast-track patients with a control group shows that numbers of complications for the fast-track patients were not significantly higher than for the control group 39% vs. 32% and more recent data show fewer in the fast-track group.1 About half the fast-track patients are discharged within three to five days after their operations, as compared with an average post-op stay of more than eight days for the routine bypass patient.
"About 20% of our CABG patients are placed on the fast track," says Jackie Anderson, RN, MSN, cardiovascular surgery outcomes manager for St. Luke’s. The percentage could be higher, she says, but patients are referred to the Texas Heart Institute because they have comorbidities or problems so complex that less specialized hospitals are unable to treat them.
The hospital assesses patients’ risk before fast-tracking them by looking at previous surgeries, other diseases, and factors such as age and gender to determine the patient’s mortality risk, Anderson explains. If the mortality-risk score is 5% or less, the patient is included in the fast-track program. Anderson says the risk scoring tool is still being tweaked, and the hospital is collecting data to make sure the tool is picking up the right patients.
The fast-track approach distinguishes itself in the following ways:
• Patients are weaned from the ventilator within 3 to 4 hours. The typical patient might stay for 6 hours.
• The monitoring lines and chest tubes are removed the day after surgery. Other patients would remain intubated for 48 hours.
• Fast-track patients are typically transferred to the acute care area the day after surgery, and their care is aggressive to increase mobility.
• Post-op antibiotic prophylaxis is kept to a minimum.
Anderson says the hospital has found that if the right patients are chosen for the program, prophylactic measures aren’t necessary to reduce complications. But, she says, they are always looking at other ways to reduce post-op complications. For example, now they are looking at a predictor model for sternal wound infections so they can recognize high-risk patients. "If we can identify patients at highest risk for infection, which we think we can, we can treat patients preoperatively and maybe develop a different approach to preparing them for surgery, " Anderson explains.
Reference
1. Alexander WA, Anderson JJ, Jesurum JT, et al. Seminars in Perioperative Nursing 1996; 5:12-22.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content