Progress in cardiovascular nursing
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Prog Cardiovasc Nurs · Jan 1997
Collaborative care: improving patient outcomes in cardiovascular surgery.
Collaborative care, a multidisciplinary process to standardize and streamline care for selected case types, has gained momentum as a care delivery system in health care settings. The major goals of these programs are to improve the quality and continuity of care, while decreasing length of stay and cost. This article will describe key components, issues and challenges of developing, implementing and evaluating a collaborative care program for cardiovascular patients. ⋯ In regard to clinical outcomes, no significant differences were found in mortality or complication rates, such as postoperative bleeding, dysrhythmias and infection rates, between the clinical path group and a comparable group of non-path patients. Both intensive care unit (ICU) and overall hospital length of stay were concomitantly reduced. Other examples of program evaluation are also described, such as variation and patient follow-up data, to highlight quality improvement initiatives that further improve quality of care and reduce length of stay for this patient population.
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Prog Cardiovasc Nurs · Jan 1996
Comparative StudyClinical and cost comparison of three postoperative skin preparation protocols in CABG patients.
This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. ⋯ In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.
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Cardiac surgery is becoming more prevalent in women. Previous knowledge and understanding regarding the process of recovery following cardiac surgery have been based predominantly on what has been known about men. Knowledge is needed regarding factors which may be particular to women's recovery from cardiac surgery and which include both biophysical and psychosocial components. ⋯ Preoperative (baseline) data were collected from 31 women who presented for cardiac surgery at two Northern California hospitals. Following discharge from the hospital, 27 women were followed monthly by telephone for three months to obtain subjective responses regarding postoperative symptoms, perceptions of recovery, activity, and health status. The findings indicate that women's perceptions of recovery are independent of NYHA functional classification, and these perceptions improve before other more objective measures of activity or health state demonstrate improvement.