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ONE
STOP POST OPT
Author: Health Care Visions Consultants
Implementing an open heart surgery (OHS) program presented
the opportunity for several community based hospitals to
challenge the way they had been providing patient care and
establish an innovative approach to post surgery patient care.
The One Stop Post OpT cardiovascular recovery unit was designed
to receive the OHS patient directly from the operating room and
to be the "care unit" for the patient's entire stay.
Patient flow, quality monitoring and caregiver acceptance in
this unit requires new paradigms from the traditional two or
three step post OHS care delivery process. The One Stop Post OPT
model focuses the delivery of care on the patient. With proven
success in clinical outcomes, and patient, physician and
caregiver satisfaction it
is anticipated that this new approach will drive hospitals to
evaluated how to integrated clinical process with physical plant
planning in the future.
Features and Benefits
The One Stop Post OpT concept of post-operative open-heart
surgery care provides patient focused care across the continium,
from the pre and immediate post-op period until discharge. The
level of patient care changes, the equipment changes, but the
patient remains in the same room receiving care from the same
nursing staff. While this is not a new concept to health care,
it is relatively new to post-operative open heart surgery
recovery. In traditional open heart surgery recovery models the
patient is transferred from an Intensive Care Unit to an
intermediate care unit and possibly to a non-monitored bed prior
to discharge. The traditional process moves the patient to the
care source instead of applying a patient responsive approach
that delivers services directly to the hospital's customer.
The One Stop Post OpT model reduces care costs by eliminating
inefficiencies associated with transfers. Streamlining care
delivery affects length of stay as consistent caregivers,
familiar with the patients and the medical conditions that can
occur following OHS surgery, recognize and immediately address
complications. The nurses in "one-stop CVU units" are
clinical
specialists in pre and postoperative open-heart surgery care,
experts in early recognition of clinical complications and can
provide rapid intervention, optimizing clinical pathway variance
monitoring and management. In addition, One Stop Post OPT
nursing and ancillary staff address patient discharge issues of
homecare, family support and skilled facility placement,
eliminating a fragmented planning process that can frequently
occur when patients are transferred to several post operative
care units.
Physicians, nurses and ancillary staff have the opportunity to
bond as a continuous quality improvement team that can
experience the success of discharging patients who have
recovered from their OHS surgery. This is "real time"
quality
feedback. Satisfaction is not limited to patients and families;
physician, staff and ancillary personnel appreciate this
innovative approach to care. The One Stop Post OpT model
provides an environment that facilitates staff empowerment and
ownership with all caregivers focusing on the entire recovery
process.
Key Points
Excellent satisfaction: Patients, Nurses, Physicians
The
One Stop Post Op T cardiovascular recovery unit has documented
results that patient satisfaction can be improved with this
innovative care delivery model. Nursing retention was higher and
was attributed to increased job satisfaction while working in a
unit that implemented this model. Physician survey scores
reported excellent grades for patient care and nurse response.
Lowered length of stay Crossed trained
multifunctional
teams review each patient's clinical progress and care needs
daily. The recovery variance monitoring results in improved
clinical pathway management. Patient progress is reviewed with
aberrations addressed, often resulting in no delay in the
patient's progression. This real time process permits patients
to "catch-up" to their expected course of recovery
resulting in
lowered length of stay and lower cost of care.
Operational and staffing cost efficiencies Patients
in
the One Stop Post OpT are cared for by nurses with advanced
critical assessment skills and cardiovascular recovery care
experience who are prepared to identify post-op complications
and address care needs earlier. Problems are identified and
resolved quickly with all members of the team understanding
their role. The One Stop Post OpT facilitates continuous quality
enhancement in one setting. Staffing is flexed to optimize
resources and can be adjusted every four hours.
Continuous communication Due to the specialized
nature
of post operative open heart surgery care and the need for a
dedicated care team, the care givers share a common goal and
have constant opportunity to dialogue. The patient is not moved
and the same nurses, physicians, and support staff care for them
during their entire stay. Active family communication and
involvement is a corner stone of this delivery system, making
the patient and their family the focus of all activity. The
patient and family receive education from the same staff that is
administering the post operative care. They are encouraged to
question therapies and treatments and are involved in care
decisions through out the patient hospital stay.
Active family involvement The One Stop Post OpT unit
fosters an environment centered on patient and family. Family
visiting is open and supported with rooms optimally designed to
address this unit's approach. The family is included in the
pre-operative teaching and continues to be an active participant
in the educational process through patient discharge.
Interactions with familiar nursing staff promote active
communication. The families have also found that the surgeons
are frequently in the unit and available to discuss the
patient's recovery process and answer their questions.
Employee ownership Another unique feature of The One
Stop Post OpT model is that it creates an empowering
environment, which fosters ownership. The nursing and ancillary
staff assigned to these units tend to refer to the OHS patients
as "our patients". The opportunities for bonding
between staff,
patients and families are extraordinary. Medical direction
provides for a defined understanding of duties and
responsibilities so that unit performance expectations are clear
and achievable for caregivers.
Clinical expertise The nursing care provided in The
One
Stop Post OpT cardiovascular unit is highly specialized. Nurses
who traditionally worked in short term recovery units are caring
for patients through out their hospital stay and are encouraged
to approach patients from a holistic platform. Caregivers
interact with patients and families through the continuum of
care and are able to appreciate the success of patient
discharge. Nurses with critical care skills provide care at all
levels. This expertise provides the opportunity for
extraordinary trust between physicians, patients, families and
ancillary staff. Complications are recognized quickly by nursing
staff and timely response can prevent compromise to the
patient's condition.
Distinguish your program from the competition The
traditional care delivery method of transferring patients based
on acuity is utilized by most facilities nationwide. By
implementing the One Stop Post OpT approach to open heart
surgery recovery, hospitals can offer differentiated and
distinguish care. Reduced length of stay and exemplary clinical
outcomes are the benchmarks of a successful program that will be
attractive to the community and payors of healthcare. The
satisfaction achieved by patients and stakeholders will clearly
set this type of open-heart surgery program apart from the
others.
About the author:
Health Care Visions offers specialized expertise and consulting
services to assist hospitals in evaluating existing or emerging
opportunities in cardiovascular (CV) and peripheral vascular
(PV) services. HCV consultants are nurses and project mangers
who have recent experience in managing successful CV and PV
programs for hospitals ranging from small institutions to some
of the country's largest and most prestigious health care
systems.
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