Development of Preparation and Continuity of Care Model for Open Heart Surgery Patients in Khon Khaen Hospital

Abstract

Open heart surgery is a major operation which is complicated and takes a high risk. According to open heart surgery patients care statistical data in 2015, the mortality rate while waiting for surgery, 6.95 %, day of surgery postponement rate in case patients do not behave properly as preoperative recommendations, 17.83%, readmission rate, 17.06%, average length of stay, 18 days. One of the causes is pathology of disease and there is not an obvious guideline for preparation and continuity of care. Related staffs are not confident in continuity of care. Moreover, patients and family are anxious about surgery, fear of surgery and do not behave properly both pre and postoperative. The purposes of this study were to develop a model of preparation and continuity of care for open heart surgery patients. This study was an action research. The samples were multidisciplinary team with the total of 18 people and patients with the total of 111 people. The research framework used in this study was PAOR – Kemmis & Mc Taggart process. It consists of: Plan: analyzing the situation by reviewing medical records, interviewing patients and family and brainstorming from related staff in hospital network; Action: (1) creating the guidelines for preparation and continuity of care for open heart surgery patients, (2) creating the manual, instructional media and guidelines for counseling, (3) holding a workshop for related staff; Observe: implementing and monitoring the developed guidelines to patients who have an appointment for open heart surgery in 2016; Reflection: evaluating outcomes, analyzing problems and obstacles and improving development plans. The tools used in this study were interview and group discussion form, data recording form and nursing outcome indicators recording form. Data were collected by observation and inquiry. Quantitative data were analyzed by statistics, frequency and percentage and qualitative data were analyzed by content analysis. The results of the study were as follows: (1) The model for preparation and continuity of care for open heart surgery patients was created and nurse case manager is one of staff who prepares patients before surgery, attend to surgery and discharge planning, take a role of counselor and using telephone to follow up postoperative patients and coordinate with hospital network in continuity of care. (2) The results of using this model found that the percentage of patients behaved properly as preoperative recommendations and guidelines increased from 80.62% to 92.79%, day of surgery postponement rate in case patients do not behave properly as preoperative recommendations decreased from 1.83% to 2.62%, mortality rate while waiting for surgery decreased from 6.95% to 1.79%, readmission rate within 28 days decreased from 17.06% to 6.30%, average length of stay decreased from 18 days to 13 days, the telephone counseling amount to 7 cases a day on average and coordinating with hospital network for adjusting a medication amount to 9 cases a week on average.