The effect of a 'fast-track' unit on the performance of a cardiothoracic department

• Published in: Annals of the Royal College of Surgeons of England 2000-01, Vol.82 (1), p.53-58
• Main Authors: Hadjinikolaou, L, Cohen, A, Glenville, B, Stanbridge, R D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiology Service, Hospital - economics; Cardiology Service, Hospital - organization & administration; Coronary Artery Bypass; Hospital Information Systems; Hospital Units - organization & administration; Humans; Income; London; Postoperative Care - methods; Practice Guidelines as Topic; Progressive Patient Care; State Medicine; Thoracic Surgery - organization & administration; Treatment Failure
• ISSN: 0035-8843; 1478-7083

The objective of this study was to describe the impact of a 'fast-track' unit, combined with a computerised system for information collection and analysis, on the clinical practice and finance of a cardiothoracic department over the first 12 month period of its application. Within 12 months, starting December 1996, 642 major cardiothoracic cases were performed at the Cardiothoracic Department, St Mary's Hospital, London, after the establishment of a 3-bed 'fast-track' unit, which was supported by a computerised system for admission planning and a pre-admission clinic. The main outcome measures were operating numbers, financial income, patient recovery and operative mortality. The 'fast-track' unit resulted in an increase of the operating numbers (11.3% increase in major cardiac cases) and income (38%), as compared with the year before. Some 525 patients out of 642 (81.8%) were scheduled for the 'fast-track' unit and 492 (93.7%) were successfully 'fast-tracked'. Coronary artery bypass grafting operations had the lowest 'fast-track' failure and mortality rates. Re-do operations and complex coronary procedures presented a high 'fast-track' failure rate of approximately 20-25%. Low cardiac output, postoperative bleeding and respiratory problems were the most frequent causes for 'fast-track' failure. The development of a 'fast-track' unit, supported by a computerised system for information collection and analysis and a pre-admission clinic, has resulted in a substantial improvement of operating numbers and financial income, without adversely affecting the clinical results. This task demanded close collaboration between a dedicated list manager and a designated member of the medical team. Patient selection with appropriate 'fast-track,' criteria may improve further the efficiency of 'fast-track' units in the future.