Shared medical appointments after cardiac surgery-the process of implementing a novel pilot paradigm to enhance comprehensive postdischarge care.

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.