By Sharon Harris R.N. CVN-BC BSN and Anna Hanson R.N.CVN-BC BSN
A hospital in California has turned the standard pre-admissions, or pre-admit, process for cardiac surgery patients on its head. For years, John Muir Medical Center, Concord Campus, had followed the standard pre-op process, which went something like this:
This could turn into a very long, frustrating day for the patient and their family, especially for those who had traveled some distance to get to our hospital.
But what if the phlebotomist, the respiratory therapist, the non-invasive technician came to the patient? Nurses overseeing the pre-op process for cardiac surgery patients decided to try it out. Their new process would focus entirely on the needs of the patient — not the testing departments.
Sharon Harris R.N. CVN-BC BSN, and fellow nurse Anna Hanson, R.N.CVN-BC BSN, needed help, though, and enlisted Mended Hearts members to assist. In addition to Mended Hearts volunteers, Harris and Hanson also asked hospital volunteers who had had previously had heart surgery to help.
Al Malick is one of several heart patients members participating in the program. He’s been a Mended Hearts member since 2008 and a part of the new pre-admit process since it began in 2010.
“Heart surgery patients who come into he hospital are scared, and their families are scared, because this is a big procedure,” says Malick, who had heart surgery in 2006. “And I remember my own experience. To talk to someone who’s been through a similar surgery is a huge benefit to the patient and their families.”
“The majority of our patients found the visit with the Mended Hearts volunteer to be reassuring,” Hanson says.
The cardiac surgery pre-admission program also includes a specially trained registered nurse. A relationship is established with the patient and family, from the pre-operative phase, the day of surgery, hospitalization and the post-discharge follow-up phone calls.
The patient is scheduled for the pre-admission day by the surgery scheduler in the cardiac surgeon’s office. Upon notification of the appointment date/time, the RN calls the patient providing instruction and information as what to expect. The RN arranges for a Mended Heart volunteer for the specific date/time that has been set for this patient.
On the day of the appointment, the patient is admitted into the system by a Registration Clerk, whose office is just next door to the pre-admit RN office. In the next office is the pre-admit testing area. This close proximity keeps the patient in one location, making it easier and less stressful than having to walk from department to department.
The Mended Heart volunteer then calls each testing department and has them come to the patient. The lab, EKG and pulmonary function studies are completed in this testing area. The Mended Heart volunteer escorts the patient to the near-by Radiology department for the chest X-ray and carotid ultrasound. During the “down” time between tests, the volunteer discusses their experiences with heart surgery being mindful to refer all medical questions to the RN.
The Mended Hearts member or hospital volunteer instructs the patient how to use the heart pillow, which is used to support the surgical site when the patient coughs, sneezes or changes position. This same volunteer who saw the patient prior to surgery will try and visit the patient while they are recovering in the hospital.
When the testing is completed, the patient is escorted by the volunteer to the pre-admit RN office located close to the testing room. The RN completes the admission interview and pre-operative teaching and then assesses the patient for crucial medication reconciliation, potential discharge issues, mobility issues, and possible infectious disease processes.
This patient-centered approach has improved the efficiency of the testing process and decreased the level of frustration and stress for cardiac surgery patients. Positive feedback has been received from patients and families who greatly appreciated the opportunity to work with the pre-admit RN’s and the Mended Heart members.