Clinical risk assessment: identifying patients at high risk for heart failure.

Care requirements differ for individual patients in the heart failure continuum of care. Few tools exist that enable the bedside nurse to assess the cardiac surgical patient effectively. A quality improvement project was conducted at a level I trauma center in the mid-Atlantic United States to identify perioperative heart failure patients who do poorly after cardiac surgery. The surgical patient who is at high risk for adverse events after coronary artery bypass graft surgery can be identified by clustering 11 characteristics. Of 1,971 patients studied, 294 had adverse outcomes. Data indicated that any cluster of the characteristics was intensified when emergency status was added.