SUMMARY
At Fairview Southdale Hospital, physicians, clinic staff, surgery staff and other hospital
department employees worked together to create a more patient-centered approach to preparing
patients for cardiac surgery. We streamlined the multiple stops for the patients; decreased the
time the patients spend at the hospital getting the required information; improved
communications and hand-offs between the caregivers; and provided all patients best practice
pre-operative screening for potential infection control issues. This method is now being spread
to other community hospitals.
NARRATIVE
Fairview Southdale Hospital has been a community leader in health care for cardiology
patients since its inception in 1965. With extraordinary physicians, great staff, and outstanding
facilities, Fairview Southdale has helped treat thousands of patients with cardiac illness and
disease annually. However, even with all our advances, there are ways to enhance the
experience our patients have before heart surgery. In 2013, hospital leadership, physicians and
hospital and clinic staff came together to improve the pre-surgical heart surgery process to
reduce fragmented care and siloed services while enhancing the patient experience. The results
were a success and the program has succeeded in accomplishing many of its goals.
To start, the team wanted to break down barriers, and look at where services would be
best delivered so that a patient has the most comprehensive experience possible. The first major
change involved moving pre-surgery patient education from the hospital to the clinic. Prior to
the change, patients would have to arrange for a separate visit to the hospital that would take up
to four hours. After streamlining the process, a patient who is identified as needing surgery
meets with a physician’s assistant at the same clinic visit and receives hands-on teaching and any
necessary labs or imaging. Patients also receive education materials specific to where they are at
in the care process.
Another process change the team focused on was the introduction of swabbing to test a
patient for methicillin-resistant Staphylococcus aureus (MRSA). This was an emerging best
practice during the time that the education process was being updated and was integrated into the
clinic visit. Patients are now tested for MRSA at the clinic, which is key to treating patients
proactively to prevent surgical site infection (SSI) the day of surgery. Incidentally, after the
successes noted with heart surgery patients, this practice has had a halo effect, spreading to other
specialties and surgery types.
By moving services to the clinic, the patient’s experience before the day of surgery was
streamlined. It eliminated a pre-surgery hospital visit and provided an opportunity to bring
services to the patient rather than having the patient seek out their services.
After shifting many pre-surgery services to the clinic, the team turned its attention to the
pre-op process the day of surgery. The first change we made was to the pre-surgery bathing
process. Prior to implementing changes, patients would arrive at the hospital, shower in a
bathroom on site, then proceed to be clipped of hair on the chest, groin and legs while sitting in
the admission bay. This process was often embarrassing for the patients and required extra
assistance. Now, patients receive education and soap on how to shower at home. The patients
come to the hospital the day of surgery already bathed for surgery. The clipping is now done in
the operating room.
The preop admission process was revised to introduce a primary care nursing model
where the nurse performs the patient interview, treats MRSA-positive patients with indicated
medication to prevent SSI, performs incentive spirometry and documents to be a baseline for
post-op ventilatory goals. The same nurse works with anesthesia to provide conscious sedation
while placing the central and arterial lines needed for monitoring the patient’s condition during
surgery. The current primary care nursing model has eliminated the need for nurse handoffs, has
reduced wait times for patients and provides a safer, more comprehensive, seamless experience
for patients.
All of the changes described above have lifted the heart surgery program at Fairview
Southdale Hospital to even greater heights than before. The new model of delivering patientcentered pre-surgical care supports the wonderful clinical outcomes we have long experienced.
By reducing steps and focusing on providing patients with what they need when they need it, the
team was able to arrive at a new way of delivering care that is better positioned to take our
program forward.