CNP Hospitalist-Cardiac Surgery, Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio, USA.
J Cardiovasc Nurs. 2010 Mar-Apr;25(2):124-9. doi: 10.1097/JCN.0b013e3181beb124.
To facilitate the physical and emotional needs of patients undergoing cardiac surgery and their families, our Cardiac Surgery Outpatient Clinic at Cleveland Clinic, a nonprofit multispecialty academic medical center in Cleveland, Ohio, decided to implement a trial of a novel care delivery paradigm called Shared Medical Appointments (SMAs). The purpose of this venture was to facilitate timely access to care 3 to 5 days after hospital discharge, include family members in the education process and the care of the patient, and provide a forum for support and shared learning among patients who have been through like surgical experiences. The clinic system, which performed 3,597 open heart surgeries and 213 robotically assisted cardiac surgeries in 2008, already used family education classes to provide instruction to the patients and family prior to surgery. Because this medium was an effective way to disseminate knowledge, we theorized that using an SMA would be an effective strategy to provide timely medical care after discharge and garner support, education, and increased access to timely medical care after discharge. Although there were many physicians in subspecialties performing these types of clinic visits at our institution since 2002, by the spring of 2007, a group of cardiothoracic nurses decided to perform a trial on this model in this cohort of patients and be a fully nurse-led SMA to provide comprehensive care after discharge. Preliminary patient satisfaction surveys have revealed that 92% of post-cardiac surgery patients rated the experience as good or excellent, and 82% would prefer an SMA for their next clinic visit rather than an individual visit. These data are consistent with physician-led SMA satisfaction surveys in our organization to date. Although still in its relative infancy, an SMA for this cohort appears to have merit in enhancing the support and education as well as providing for the complex medical needs of these patients.
为了满足接受心脏手术的患者及其家属的身体和情感需求，我们俄亥俄州克利夫兰市的克利夫兰诊所（一家非营利性多专科学术医疗中心）的心脏外科门诊决定试行一种名为共约医疗预约（Shared Medical Appointments，SMAs）的新型医疗服务模式。该尝试的目的是为了方便患者在出院后 3 至 5 天内获得及时的医疗护理，让患者家属参与患者的教育过程和护理过程，并为经历过类似手术的患者提供一个支持和共同学习的平台。该门诊系统在 2008 年共进行了 3597 例心脏直视手术和 213 例机器人辅助心脏手术，此前已经使用家庭教育培训课程在手术前为患者及其家属提供指导。因为这种媒介是传播知识的有效途径，我们推测使用 SMA 将是一种有效的策略，可以在出院后提供及时的医疗护理，并获得支持、教育，以及增加及时获得医疗护理的机会。虽然自 2002 年以来，我们机构的许多专科医生一直在进行这种类型的门诊就诊，但在 2007 年春季，一组心胸科护士决定在这一组患者中试行这一模式，并采用完全由护士主导的 SMA 来提供出院后的综合护理。初步的患者满意度调查显示，92%的心脏手术后患者对该体验的评价为良好或优秀，82%的患者希望在下次就诊时选择 SMA，而不是单独就诊。这些数据与我们机构迄今为止进行的医生主导的 SMA 满意度调查结果一致。尽管 SMA 仍处于相对初期阶段，但对于这一组患者来说，它似乎在增强支持和教育以及满足这些患者复杂的医疗需求方面具有一定的价值。
