RESUMO
Shortened hospital stays could potentially lead to unmet patient needs. This descriptive study utilizes critical pathway data and the Omaha System to identify the health needs of coronary artery bypass surgery patients at time of discharge. The most common health needs were education, sleep/rest and rehabilitation. Nursing implications relating to these health needs are also identified.
Assuntos
Ponte de Artéria Coronária/enfermagem , Ponte de Artéria Coronária/reabilitação , Procedimentos Clínicos/organização & administração , Avaliação das Necessidades , Avaliação em Enfermagem/métodos , Diagnóstico de Enfermagem/classificação , Alta do Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Avaliação de Programas e Projetos de SaúdeRESUMO
The literature and healthcare provider experiences leave questions about which interventions might best assist patients during interregional healthcare. The research was conducted to gain information on the current reality of interregional healthcare for patients needing tertiary cardiovascular care distant from their home. A purposive sample of patients having a cardiovascular diagnosis who were transferred for procedures or surveillance to a tertiary site were interviewed (n = 17), and their charts were reviewed (n = 27). Six broad themes were extracted from the interviews and chart reviews: healthcare provider behaviors, healthcare system issues, patient education or information, discharge from the hospital, overall reflections on the healthcare experience, and healthcare communication issues. A redesign of interregional healthcare is needed to address the areas of care and expert behaviors by providers, documentation, continuity, communication, education, and rehabilitation/adaption. The advanced practice nurse is well suited to lead these practice changes.
Assuntos
Atitude Frente a Saúde , Doenças Cardiovasculares/enfermagem , Transferência de Pacientes/normas , Programas Médicos Regionais/normas , Feminino , Humanos , Masculino , Auditoria de Enfermagem , Pesquisa Metodológica em Enfermagem , Estudos RetrospectivosRESUMO
This article describes the use of rapid cycle improvement in a community hospital adult cardiac surgery program. The hospital participated in the Breakthrough Series: collaborative adult cardiac surgery sponsored by the Institute of Healthcare Improvement (IHI). As a result of this 1-year project, median length of stay for diagnosis-related groups 104 throug 108 was decreased 30 percent from 8.62 days to 6.0 days; percentage of patients extubated within 6 hours postoperatively rose from 5 percent to 75 percent; median cost per case declined $19 percent; and pain and anxiety, service, and satisfaction scores all improved. There was no adverse impact on the clinical indicators 30-day readmission rate, reintubation, return to operating room, and mortality.
