A guide to commissioning cardiac surgical services - NHS ...

A guide to commissioning cardiac surgical services
Trent Cardiac Centre, Nottingham University Hospitals NHS Trust in collaboration with East Midlands Cardiac and Stroke Network
Reducing length of stay of elective cardiac surgical patients to a one night stay post operatively
The idea
The average length of stay for people
undergoing cardiac surgery at the Trent
Cardiac Centre is around five to seven
days. The typical elective surgery
pathway includes review of the patient
in outpatients by the cardiac surgeon
where the decision to undertake surgery
is made and the patients added to the
waiting list. A week before surgery
patients are invited to attend the preoperative
assessment clinic where they
are seen by the surgeon, anaesthetist
and cardiac rehabilitation nurse. At this
appointment the full range of preoperative
tests are undertaken.
Patient and carer satisfaction levels are
high at the Trent Cardiac Centre and
feedback from patients had indicated
that some were keen to leave hospital
earlier and return to their usual
residence. We decided to test out
whether we could send selected low
risk elective adult cardiac surgical
patients home after a one night stay
post operatively following coronary
artery bypass surgery, valve surgery or
repair of atrial septal defect. An audit of
patients stratified as having a low risk
profile for cardiac surgery whose
operation was performed in the
previous 12 months highlighted that
approximately 10 percent (80 patients)
of all elective referrals may be eligible
for a shorter spell in hospital post
operatively potentially being discharged
home following a one night stay in
hospital. A shorter length of stay would
equate to saving four post operative
bed days per patient stay and a total of
320 acute beds per year.
The solution
The Trent Cardiac Centre at Nottingham
University Hospitals NHS Trust, set up a
project team with multi-disciplinary
membership representing the tertiary
unit, primary care and the national
improvement lead for cardiac surgery.
This group was led by a consultant
surgeon with project management
support from the East Midlands Cardiac
and Stroke Network.
We employed service improvement
techniques to look at the current
patient process by undertaking process
mapping and asking patient and carers
to share their views on the current
patient experience along the usual
pathway of care. A new patient pathway
was agreed detailing what tasks, support
and mechanisms would need to be in
place and delivered by who for patients
to be safely and appropriately discharged
home. The project team agreed to work
toward testing out a one night post
operative stay with 10 patients selected
against criteria.
Potential risks to patient safety were
highlighted through a risk assessment
process which helped us to consider
each of the identified risks and steps
required to mitigate these. To help us
understand the concerns patients and
carers may have regarding early
discharge from hospital we held a
workshop to identify their views and
experiences of the current service and
to gather views of the proposed shorter
pathway.
Having identified the potential risks to
early discharge and the changes
required to ensure patient safety in the
pre and post operative surgical
pathway we:
• Developed a set of inclusion and
exclusion criteria used to select the
appropriate patients.
• Produced staff handbooks assembled
to contain the full set of protocols,
information and processes to support
staff training in the pilot.
www.improvement.nhs.uk/heart
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