Streamlining the Preoperative process for the Open Heart Surgery Patient by Cynthia Havrilak, RN, MSN

Open heart surgery is considered to be a major event for patients, their families, and hospitals. Delays in surgery cause emotional distress for the patient and their family and are costly to the hospital. For these reasons, it is beneficial for all organizations providing open heart surgery services to review their processes that prepare the patient for open heart surgery. Investing the time to detail the patient flow processes involved in the preoperative preparation will assist in eliminating process gaps and identify opportunities to improve organizational communication, patient care and satisfaction. This can be accomplished by instituting a task force/ committee to assist in this area.

It is advisable to include departments involved with patient entry points into the open heart process. These departments are usually the inpatient medical cardiac units, registration area, cardiovascular surgeon office, and cardiac cath lab. Development of standardized preoperative open heart surgery orders help to create common practice routines that can reduce errors, improve the staff education, and reduce organizational costs by eliminating unnecessary tests and improving staff efficiencies. These benefits outweigh the challenge of standardizing preoperative physician orders. The orders set should be approved by the appropriate organizational committees, explained to the staff, and then distributive to appropriate departments for implementation. Included in these order sets should be preoperative lab tests, patient testing (CXR, EKG), medications, consults including anesthesia, and surgical prep. Input from the medical staff is essential to this process. The administrative leader should be well versed on latest clinical techniques and cardiovascular research ensuring best practices are addressed and not overlooked.

Some of the most common causes of delays are from inaccurate completion of blood bank procedures, long turnaround times for patient reports, a lack of the chest film or lateral view, scheduling delays for patient testing, and lost pieces of the patient’s medical record. Addressing these topics during patient flow planning is essential in expediting the presurgery process. Once process gaps are identified it is important to develop a workable solution and education plan. Ongoing continuous quality management can evaluate the effectiveness of the changes and identify any additional needed areas of improvement.

The outpatient preadmission process should be flow charted to facilitate a smooth patient transition through the appointment schedule. This is the patient’s introduction to your heart program and efforts should be directed at providing the patient with a good first impression. The following issues should be addresses in the planning sessions for the preadmission appointment:

•What time of day is best to schedule preadmission appointments

•Where should the patient report

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BIO:

Cynthia Havrilak, RN, MSN is a Senior Consultant with Health Care Visions, Ltd. based in Pittsburgh, Pennsylvania. The firm brings special expertise in the cardiovascular product line and is endorsed as a Preferred Provider of Cardiac Program Development for AmeriNet. Health Care Visions has assisted a multitude of hospitals in all phases of cardiac programs from program assessment and feasibility studies to business planning and implementation.

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