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Labata C, Oliveras T, Berastegui E, Ruyra X, Romero B, Camara ML, Just MS, Serra J, Rueda F, Ferrer M, García-García C, Bayes-Genis A. Unidad de cuidados intermedios tras la cirugía cardiaca: impacto en la estancia media y la evolución clínica. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Labata C, Oliveras T, Berastegui E, Ruyra X, Romero B, Camara ML, Just MS, Serra J, Rueda F, Ferrer M, García-García C, Bayes-Genis A. Intermediate Care Unit After Cardiac Surgery: Impact on Length of Stay and Outcomes. ACTA ACUST UNITED AC 2017; 71:638-642. [PMID: 29158075 DOI: 10.1016/j.rec.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/05/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS). METHODS From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n=674) and post-IMCU-CS (May 2014-April 2015, n=650). RESULTS There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9±11 to 2.9±6 days (mean±standard deviation; P<.001); 2 [1-4] to 1 [0-3] (median [Q1-Q3]); in-hospital length of stay decreased from 13.5±15 to 12.7±11 days (mean±standard deviation; P=.01); 9 [7-13] to 9 [7-11] (median [Q1-Q3]), in pre-IMCU-CS to post-IMCU-CS, respectively. There were no statistically significant differences in in-hospital mortality (4.9% vs 3.5%; P=.28) or 30-day readmission rate (4.3% vs 4.2%; P=.89). CONCLUSIONS After the establishment of an IMCU-CS for postoperative cardiac surgery, there was a reduction in ICU and in-hospital mean lengths of stay with no increase in in-hospital mortality or 30-day readmissions.
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Affiliation(s)
- Carlos Labata
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Teresa Oliveras
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Berastegui
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xavier Ruyra
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Bernat Romero
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria-Luisa Camara
- Servicio de Cirugía Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria-Soledad Just
- Servicio de Medicina Intensiva, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Instituto de Investigación en Ciencias de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Brown MM. Implementation strategy: one-stop recovery for cardiac surgical patients. AACN CLINICAL ISSUES 2000; 11:412-23. [PMID: 11276655 DOI: 10.1097/00044067-200008000-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
"Fast-track" or "rapid recovery" for cardiac surgical patients is enjoying widespread use due to its benefits of increased patient comfort, enhanced quality of care, and cost-savings. Successful implementation of a fast-track program, however, may be challenged by physicians, the institution, or patients and their families. One-Stop Recovery is a fast-track program that emphasizes the benefits of traditional rapid recovery programs while addressing potential challenges.
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Affiliation(s)
- M M Brown
- APACHE Medical Systems, Inc. National Health Advisors, McLean, Virginia, USA
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