CARDIAC SURGERY AN MCN PERSPECTIVE

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CARDIAC SURGERYAN MCN PERSPECTIVE

• Nichola MacDuff
• Cardiac Liaison Service
• Mr Sai Prasad
• Consultant Cardiac Surgeon

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BACKGROUND

• 7 Cardiac Surgeons
• 7 Health Boards
• 27 Cardiologists
• 850 operations per year
• 357 patients currently waiting for surgery
• - 178 CABG
• - 32 CABG Valve repair/replacement
• - 80 Isolated valve repair/replacement
• - 25 other procedures (aortic aneurysms/GUCH
  etc)

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THE LIAISON SERVICE

• Research has shown that the most stressful time
  for Cardiac patients is
• - When they hear they need surgery
• - When they discuss the risks of cardiac surgery
• - When they get their operation date
• Most of our efforts are aimed at providing
  reassurance, information and support for our
  patients while waiting for surgery

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AIMS OF THE SERVICE

• To support patients and their relatives/carers
  from referral to discharge
• To provide a single point of contact for patients
  and their relatives
• To ensure the patient journey is a seamless
  process from referral to discharge
• To manage the pre-operative preparation of
  cardiac surgical patients
• To provide information, advice and health
  education
• To improve the patient journey

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CHALLENGES

• FOR THE DEPARTMENT

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WAITING LISTS

• Scotland has the lowest wait-time for cardiac
• surgery in the UK
• Current directives
• CABG 16 weeks
• Valve 26 weeks
• Other procedures 26 weeks
• Future directives
• CABG and Valve 10 weeks
• Other procedures 16 weeks

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Planning issues

• Equity of access to services
• Diverse ways in which patients access the service
• Elective vs urgent workload
• - Clinical prioritisation
• - increasing in-patient workload
• - waiting-time guarantees
• Case mix and patient flows
• Golden Jubilee Hospital
• Manpower
• Skills, training and education

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Planning Issues

• Infection control
• - compliance with hospital protocols
• - pre-admission screening
• - isolation facilities
• Bed management
• Investigations / treatments required
  pre-operatively
• Specialist procedures additional funding
  requirements

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Patient issues

• Loss of earnings
• Social needs
• - Respite for dependants
• - post-discharge needs
• - Post-operative recovery
• - Special needs (learning disabilities, etc)
• Stress (patient and relatives/carers)
• Deterioration clinical change while waiting for
  surgery
• Distance from the service

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Traditional approach

• Written referral from Cardiologist to Surgeon
• 1 week prior to surgery patient informed of
  admission date by letter
• Patient admitted 2 days prior to surgery.
• Meets surgeon
• Undergoes pre-op work up
• Problems
• High rate of cancelled operations
• No patients available at short notice to fill
  cancelled slots
• Inadequate communication between surgical
  team/patient
• Prolonged hospital stay

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The New Patient Journey
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RECENT SUCCESSES
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THE LIAISON SERVICE

• Only 3 cancellations (out of 850 operations) as a
  result of a patient being insufficiently prepared
  for surgery
• A recent audit of patients indicated that 100
  valued the service we provide, particularly the
  dedicated helpline which allows for direct access
  to the department a single point of reference

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Pre-admission Clinics

• Source of information and support for patients,
  relatives and/or their carers
• Opportunity for reassessment of patients who have
  not been seen since referral
• Management of risk
• Management of expectation
• Opportunity for patients to meet others in a
  similar position
• Entirely nurse-led

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SQIP(SCOTTISH QUALITY IMPROVEMENT PROGRAMME)

• Programme of national audit
• Part of drive to improve standards in cardiac
  surgery
• RIE was first unit to be evaluated
• Findings
• - Positive feedback on all aspects of unit
• - Particular mention made of excellent infection
  control measures
• - need further investment in equipment to
  support service (eg. TOE probes)
• - Quality of audit data 98.5 accurate

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Future Challenges

• Modernising Medical Careers
• Further development of nurse-led services
• Advances in investigation and treatment of
  Coronary Heart Disease (medical surgical)
• Increasing numbers of patients returning for redo
  operations, resulting in increasing complexity of
  caseload.
• Further reduction in waiting time guarantees
• Single database (TOMCAT)
• Bed management
• Recruitment retention of staff

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QUESTIONS?