The Role of Nurse-led Post-Operative Cardiac Clinics:

A Fifteen Month Experience in Wales

Sister Ann Parkes, Mr Dheeraj Mehta and Miss Melanie Jenkins

Cardiff & Vale UHB

Standard Routine Follow-up Practice:

All CABG follow up patients were seen in the Consultant clinic 6 – 12 weeks post-op.

Main pressures on clinics = reduction in junior doctors working

hours

QUESTION: Could specific post-op patients be seen by experienced nurses, instead of a doctor?

Pilot Study Criteria for inclusion in the clinic Patients who had undergone CABG only

Clear objectives: To have a follow up appointment within 6-8 weeks of discharge,

To discharge patient back to referring cardiologistTo optimise secondary prevention medicationTo optimise risk factor modification

To free up medical manpower

Structured proforma / supervision Clinical support available

Post-operative Complications Prior to Clinic Visit

Post-op complications38%

Readmitted12%

No issues50%

N = 183

N = 17

Postoperative Complications at Clinic Visit

0

10

20

30

40

50

60

70

80

90

No of patients 87 15 11 37 3

No Issues Wound issues Arrythmias oedema Pleural effusions

47.5%

34% 6%

20%

1.6%

N = 183

Medication Changes initiated from Clinic Visit

No Changes42%

heart Failure/anti-hypertensives

37%

Anti-arrythmic5%

Anti-platelet8%

Diuretics8%

Referrals made following clinic visit

0

2

4

6

8

10

12

patients 3 7 3 5 5 1 5 12 6

Admitted via clinic

Cons Surgeon

EPSSmoking cessation

DieticianDiabetic Nurse

Cardiac Rehab

Cardiol clinic

ED Clinic

N = 183

Discharges

Discharged95%

Follow-up Cons Clinic5%

Nurse led follow up clinic post CABG

Provides challenges It is as safe and effective as that of a medic run

clinic. Supportive environment & training vital It is cost effective as it frees up medical man-

power. Complications are clearly highlighted and

managed with the full support of the surgical team as necessary.

The Way Forward:

PCI Cardiology clinic

Future plans are to develop a clinic for post-operative valve surgery

To provide training for recent newly appointed nurse practitioners to assist and cover in the clinics

Thank you.

Any Questions?