Redesigning the care of carotid endarterectomy patients

Recent studies have supported the effectiveness of carotid endarterectomy (CEA) as a treatment for significant carotid stenosis. 1,2 While the efficacy of CEA has been established, it is important to review the processes and outcomes of care to ensure high-quality, cost-effective care. As part of a...

Full description

Saved in:
Bibliographic Details
Published in:Journal of vascular nursing 1997-03, Vol.15 (1), p.8-12
Main Authors: Blackburn, Karen, Neaton, Marie E.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Algorithms
Cost Control
Critical Pathways
Endarterectomy, Carotid - adverse effects
Endarterectomy, Carotid - economics
Endarterectomy, Carotid - nursing
Female
Humans
Length of Stay
Male
Middle Aged
Nursing
Nursing Audit
Patient Discharge
Retrospective Studies
Total Quality Management
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Recent studies have supported the effectiveness of carotid endarterectomy (CEA) as a treatment for significant carotid stenosis. 1,2 While the efficacy of CEA has been established, it is important to review the processes and outcomes of care to ensure high-quality, cost-effective care. As part of a quality-improvement process, our hospital's Vascular Surgery Quality Improvement Team redesigned the care for patients having CEA surgery. Practice changes, implemented in January 1995, included routine discharge on the first postoperative day, a new critical pathway supported by a computerized order set, a switch from general anesthesia to a regional block approach, and the use of an algorithm in treating postoperative hypertension. The impact of these changes on cost and quality were then analyzed. A retrospective chart audit was completed on 185 CEA surgeries performed in 1995. Length of stay decreased by 1.15 days, and costs were reduced by $1900 per case, with no change in postoperative morbidity or mortality rates. The incidence and severity of postoperative hypertension, bradycardia, and hypotension were also analyzed, supporting the practice changes and the current level of nursing care.
ISSN:1062-0303
1532-6578
DOI:10.1016/S1062-0303(97)90047-9