2.50
Hdl Handle:
http://hdl.handle.net/10755/164275
Category:
Abstract
Type:
Presentation
Title:
A Process Redesign to Ensure A Successful Long Term Outcome From the Cox-Maze Procedure
Author(s):
Dunning, Elizabeth; Fleisher, Mechelle; Halpin, Linda; Henry, Linda
Author Details:
Elizabeth Dunning, MSN, Inova Heart and Vascular Institute, Falls Church, Virginia, USA, email: nacnsorg@nacns.org; Mechelle Fleisher; Linda Halpin, MS, RN; Linda Henry, PhD, RN
Abstract:
Purpose: Re-design the process of post-operative/post-discharge care of the surgery patient to ensure success of the procedure (return to sinus rhythm). Significance: Medication, rhythm management, and appropriate timing of cardioversion post procedure are measures crucial to the success of the procedure and require collaboration of health care providers. Design: Atrial Fibrillation (AF), the most common cardiac dysrhythmia in the United States, creates hemodynamic instability, decreased quality of life and increased risk of thomboembolic events. This procedure offers the medically refractory patient a potential cure with success defined as return to normal sinus rhythm off all anti-arrhythmic medications. After the first procedures were performed at our facility, uncertainty was expressed concerning patients' required post operative/ post discharge care. Methods: Our process re-design was a three phase process. Phase one- education for health care providers and patients. Held three surgical procedure and post- procedure medication regimen "Lunch and Learns". Development of post- surgery and post-discharge protocols. Development of a surgery/cardiology interoffice collaboration for post discharge management. Development of an educational brochure for clinicians and patients. Phase two- Impact of this procedure on patient's quality of life (QOL). QOL (SF12) surveys were distributed pre-op, 3, 6, 12 and 24 months postop. Phase three- clinical data collection post-discharge to confirm current rhythm, hemodynamic stability, bleeding and the incidence of thromboembolic events. Findings: Since September 2004, 204 patients have undergone the procedure. Mean follow up is 11.4 (SD 7.3) months with a success rate of 85%. There has been a 63% increase in the number of patients following protocol. The current survey response rate is 82%. The norm based physical function scores (QOL) from baseline to 6 months postoperatively have increased an average of 12 points (p<.0001). 2.5% (N=5) experienced either a thromboembolic event or bleeding. Conclusions: The success of the Procedure is directly related to having a cohesive, collaborative process in place that begins preoperatively and continues through at least the first year post-discharge. Implications for Practice: Starting a new procedure requires hospital care and follow-up be designed, implemented and coordinated among all care givers.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2008
Conference Name:
Clinical Nurse Specialists: Leaders in Clinical Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Atlanta, Georgia, USA
Description:
Conference theme: Clinical Nurse Specialists: Leaders in Clinical Excellence, held March 5 - 8 at the Westin Peachtree Plaza in Atlanta, Georgia
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleA Process Redesign to Ensure A Successful Long Term Outcome From the Cox-Maze Procedureen_GB
dc.contributor.authorDunning, Elizabethen_US
dc.contributor.authorFleisher, Mechelleen_US
dc.contributor.authorHalpin, Lindaen_US
dc.contributor.authorHenry, Lindaen_US
dc.author.detailsElizabeth Dunning, MSN, Inova Heart and Vascular Institute, Falls Church, Virginia, USA, email: nacnsorg@nacns.org; Mechelle Fleisher; Linda Halpin, MS, RN; Linda Henry, PhD, RNen_US
dc.identifier.urihttp://hdl.handle.net/10755/164275-
dc.description.abstractPurpose: Re-design the process of post-operative/post-discharge care of the surgery patient to ensure success of the procedure (return to sinus rhythm). Significance: Medication, rhythm management, and appropriate timing of cardioversion post procedure are measures crucial to the success of the procedure and require collaboration of health care providers. Design: Atrial Fibrillation (AF), the most common cardiac dysrhythmia in the United States, creates hemodynamic instability, decreased quality of life and increased risk of thomboembolic events. This procedure offers the medically refractory patient a potential cure with success defined as return to normal sinus rhythm off all anti-arrhythmic medications. After the first procedures were performed at our facility, uncertainty was expressed concerning patients' required post operative/ post discharge care. Methods: Our process re-design was a three phase process. Phase one- education for health care providers and patients. Held three surgical procedure and post- procedure medication regimen "Lunch and Learns". Development of post- surgery and post-discharge protocols. Development of a surgery/cardiology interoffice collaboration for post discharge management. Development of an educational brochure for clinicians and patients. Phase two- Impact of this procedure on patient's quality of life (QOL). QOL (SF12) surveys were distributed pre-op, 3, 6, 12 and 24 months postop. Phase three- clinical data collection post-discharge to confirm current rhythm, hemodynamic stability, bleeding and the incidence of thromboembolic events. Findings: Since September 2004, 204 patients have undergone the procedure. Mean follow up is 11.4 (SD 7.3) months with a success rate of 85%. There has been a 63% increase in the number of patients following protocol. The current survey response rate is 82%. The norm based physical function scores (QOL) from baseline to 6 months postoperatively have increased an average of 12 points (p<.0001). 2.5% (N=5) experienced either a thromboembolic event or bleeding. Conclusions: The success of the Procedure is directly related to having a cohesive, collaborative process in place that begins preoperatively and continues through at least the first year post-discharge. Implications for Practice: Starting a new procedure requires hospital care and follow-up be designed, implemented and coordinated among all care givers.en_GB
dc.date.available2011-10-27T11:45:19Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:45:19Z-
dc.conference.date2008en_US
dc.conference.nameClinical Nurse Specialists: Leaders in Clinical Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationAtlanta, Georgia, USAen_US
dc.descriptionConference theme: Clinical Nurse Specialists: Leaders in Clinical Excellence, held March 5 - 8 at the Westin Peachtree Plaza in Atlanta, Georgiaen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
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