Effects of clinical pathway in high risk coronary artery bypass graft patients’ outcomes

Authors

  • Phannee ฺBallung Central Chest Institute of Thailand
  • Kusuma Khuwatsamrit Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Taweesak Chotivatanapong Surgery Department, Central Chest Institute of Thailand

Keywords:

high risk group, coronary artery bypass graft, clinical pathway, hospital readmission, self-care knowledge, satisfaction

Abstract

      This study aimed to develop clinical pathway for high risk coronary artery bypass graft (CABG) patients, to exam effects of the clinical pathway on knowledge of high risk coronary artery bypass graft patients before and after the surgery as well as to evaluate both patients and the care providers’ satisfaction with the clinical pathway. The samples consisted of 40 high risk CABG patients with left ventricular ejection fraction lower than or equal to 40%. Data were collected between June and December, 2018 by using the demographic questionnaire, questionnaire of knowledge before and after surgery and satisfaction questionnaire. Data were analyzed using descriptive statistic, and paired t-test.

     The findings revealed that the patients’ knowledge after receiving the clinical pathway were higher than before implementation with a statistical significance (p < 0.01).  Moreover, both patients and nurses were satisfied with the clinical pathway in a high to a very high level.  As for clinical outcomes after the operation, it was found that 93.75% of the patients had their fasting blood sugar level lower than or equal to 200 mg/dl, about 83.3% had their systolic blood pressure equal to 130 mmHg or lower, 100% were able to control their emphysema, and 83.3% were able to quit smoking.  In addition, telephone follow-ups were conducted during the first week after hospital discharge revealed that CABG patients had sternal wound pain (100%), exertion chest pain (35%), and loss of appetite (22%). Moreover, the three most common problems follow-ups for three weeks after hospital discharge were insomnia and loss of appetite (10%), cough, sternal wound pain (7%) and exertion chest pain (5%). 

     Based on such finding, the clinical pathway is needed for high risk CABG patients to be prepared before undergoing the surgery, and to ensure continuous care both before and after hospital discharge to ensure desirable clinical outcomes after the surgery.

References

Jitauraungkoon P, Wanitkun N, Danaidusadeekul S, Tocharoenchok T. Predictors of Quality of Life during 6-18 Weeks among Patients with Post Coronary Artery Bypass Graft. Journal of Nursing Science 2017; 35 (3): 106-119. (in Thai).

Hannan EL, Zhong Y, Lahey SJ, Culliford AT, Gold JP, Smith CR, et al. 30-Day readmissions after coronary artery bypass graft surgery in New York state. JACC Cardiovasc Interv. 2011; 4: 69-76.

Surgery Department, Central Chest Institute of Thailand. Cardiovascular surgery statistic 2015-2017. Nonthaburi: Central Chest Institute of Thailand; 2018.

Espinoza J, Camporrontondo M, Vrancic M, Piccinini F, Camou J, Benzadon M, et al. 30-Day readmission score after cardiac surgery. Clin Trials Regul Sci Cardiol 2016; 20: 201-5.

Stephens RS, Whitman GR. Postoperative critical care of the adult cardiac surgical patient. Part I: Routine postoperative care. Crit Care Med. 2015; 43:1477-97.

Kline LE. The effects of implementing best practices on 30-day readmission rates in adults following CABG surgery [Doctor of Nursing Practice].Indiana: Valparaiso University; 2015.

Jitauraungkoon P, Wanitkun N, Danaidusadeekul S, Tocharoenchok T. Predictors of Quality of Life during 6-18 Weeks among Patients with Post Coronary Artery Bypass Graft. Journal of Nursing Science 2017; 35 (3): 106-19. (in Thai).

Machompoo N, Jitpanya C. The Effect of Unpleasant Symptom Management Program on Functional Status in Post Coronary Artery Bypass Graft Patients. Songklanagarind Journal of Nursing 2017; 37 (3):97-108. (in Thai).

McIlvennan CK, Eapen ZJ, Allen A. Hospital readmissions reduction program. Circulation 2015;131:1796–1803

Dang D, Dearholt S. The Johns Hopkins nursing evidence-based practice model and guidelines. Indianapolis, IN: Sigma Theta Tau, International; 2017.

Thayaparan AJ, Mahdi E. The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings [cited 2013 July 23]. Available from: https://doi.org/10.3402/meo. v18i0.21747.

Suwisith N, Hanucharurnkul S. Development of the Patient Satisfaction with Nursing Care Questionnaire. Rama Nurs J 2011; 17(2):264-277. (in Thai).

Ramkhuan C, Khuwatsamrit K, Panpakdee O. Factors related to smoking cessation behavior among patients after coronary artery bypass graft. Thai Journal of Cardio-Thoracic Nursing 2016; 27(2):2-16. (in Thai).

Jitauraungkoon P, Wanitkun N, Danaidusadeekul S, Tocharoenchok T. Predictors of Quality of Life during 6-18 Weeks among Patients with Post Coronary Artery Bypass Graft. Journal of Nursing Science 2017; 35 (3): 106-119. (in Thai).

American Heart Association. ACC/AHA 2011 Guideline Update for Coronary Artery Bypass Graft Surgery: Summery Article. Circulation 2011; 110:1-9.

ACC/AHA/HFSA. Guideline for the Management of Heart Failure. Circulation. 2017; 136: e 137-e 161.

Taghipour H, Naseri M, Safiarian R, Dadjoo Y, Pishgoo B, Mohebbi H, et al. Quality of life one year after coronary artery bypass graft surgery. Iran Red Crescent Med J. 2011;13:171-77.

McNeely C, Kwedar K, Markwel S, Vassileva CM. Improving coronary artery bypass grafting readmission outcomes from 2000 to 2012 in the medicare population. J Thorac Cardiovasc Surg. 2017; 154:1288-97.

Singhapol K, Khuwatsamrit K, Hanprasitkam K, Leelayana P. Risk factors related to surgical site infection after coronary artery bypass graft surgery. Rama Nurs J. 2014; 20(1):33-49. (in Thai)

American Diabetes Association. Standard of Medical Care in Diabetic. The Journal of Clinical and Applied Research and Education. 2018; 41(1): S86-S104.

Espinoza J, Camporrontondo M, Vrancic M, Piccinini F, Camou J, Benzadon M, et al. 30-day readmission score after cardiac surgery. Clin Trials Regul Sci Cardiol. 2016;20: 201-5.

ESC/ESH Guidelines for the management of arterial hypertension. Hypertension and Heart disease. Eur. Heart J.2018; 39: 3021–3104.

EuroSCORE [Database on the Internet]. Cambridge: euroSCORE.org; [cited 2013 June 12]. Available from: http://euroscore.org/ index .htm.

Li Z, Amstrong EJ, Parker JP, Danielsen B, Romano PS. Hospital variation in readmission after coronary artery bypass surgery in California. Circ Cardiovasc Qual Outcomes. 2012; 5: 729-37.

Sanckamanee Y, Ruisungnoen W. Effects of Preparatory Information Intervention on Knowledge, Anxiety, and Self-Care Practice among Patients Underwent Coronary Artery Bypass Graft Surgery. Journal of Nurses' Association of Thailand, North-Eastern Division 2012; 30(1):15-21. (in Thai).

Benuzillo J, Caine W, Evans RS, Roberts C, Lappe D, Doty J. Predicting readmission risk shortly after admission for CABG surgery. J Card Surg. 2018;33:163-70.

Kang YA. Risk factors and outcomes associated with readmission to the intensive care unit after cardiac surgery. AACN Adv Crit Care. 2016; 27:29-39.

Hannan EL, Zhong Y, Lahey SJ, Culliford AT, Gold JP, Smith CR, et al. 30-Day readmissions after coronary artery bypass graft surgery in New York state. JACC Cardiovasc Interv. 2011; 4:69–76.

Chintapanyakun T, Ua-Kit N, Chaiyaroj S. Predicting factors of health status among patients after coronary artery bypass graft surgery. Thai Journal of Cardio-Thoracic Nursing. 2017; 28(1):96-110. (in Thai).

Srisuantang N, Asdornwised U, Thoshingha O. The development of a Critical pathway for coronary artery bypass graft patient. [Master Thesis of Nursing Science]. Bangkok: Mahidol University; 2005. (in Thai).

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Published

2021-08-29

How to Cite

1.
ฺBallung P, Khuwatsamrit K, Chotivatanapong T. Effects of clinical pathway in high risk coronary artery bypass graft patients’ outcomes. Thai J Cardio-Thorac Nurs. [Internet]. 2021 Aug. 29 [cited 2024 Jul. 24];32(1):197-213. Available from: https://he02.tci-thaijo.org/index.php/journalthaicvtnurse/article/view/249800

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Research Articles