Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Department of Surgery, New York-Presbyterian Queens, Flushing, New York.
Ann Thorac Surg. 2022 Apr;113(4):1112-1118. doi: 10.1016/j.athoracsur.2021.07.036. Epub 2021 Aug 14.
Readmission after coronary artery bypass grafting (CABG) is associated with adverse outcomes and increased cost. We evaluated the impact of a high-value care discharge protocol on readmission, length of stay (LOS), and discharge destination in patients undergoing isolated CABG.
In 2016, a comprehensive, patient-centered discharge protocol was implemented. A nurse practitioner was the fulcrum of this program, which focused on improving health literacy, disease management, and rigorous follow-up. All patients undergoing isolated CABG between 2012 and 2019 were retrospectively analyzed with regard to 30-day readmission, LOS, and discharge disposition. Differences were analyzed by Mann-Whitney, chi-square, and t tests. Analyses were repeated using propensity matching.
A total of 910 consecutive patients undergoing isolated CABG were included in the analyses: 353 preprotocol and 557 postprotocol. Preprotocol patients had a readmission rate of 14.4% (n = 51), compared with 6.8% (n = 38) in the postprotocol patients (P < .001). Median postoperative LOS before implementation was 6 (interquartile range, 5-8) days compared with 5 (interquartile range, 4-6) days postimplementation (P < .001). Postimplementation, a higher proportion of patients were discharged to home compared with a skilled nursing facility (82.7% [n = 461] vs 73.9% [n = 261]; P = .002). After propensity matching, 298 well-balanced patients were included for analysis and these significant reductions in LOS, readmission, and discharge destination persisted.
Implementation of a new discharge protocol was significantly associated with reduced readmission and LOS, along with higher rates of discharge to home in isolated CABG patients. Importantly, the results were sustainable and did not require additional resources, delivering high-value care.
冠状动脉旁路移植术（CABG）后再入院与不良结局和增加的成本有关。我们评估了高价值护理出院方案对孤立性 CABG 患者再入院、住院时间（LOS）和出院去向的影响。
2016 年，实施了一项全面的、以患者为中心的出院方案。一名执业护士是该方案的核心，该方案侧重于提高健康素养、疾病管理和严格的随访。对 2012 年至 2019 年间接受孤立性 CABG 的所有患者进行 30 天再入院、LOS 和出院处置的回顾性分析。采用 Mann-Whitney、卡方和 t 检验分析差异。重复分析采用倾向评分匹配。
共纳入 910 例连续接受孤立性 CABG 的患者：353 例为方案前，557 例为方案后。方案前患者的再入院率为 14.4%（n=51），方案后患者的再入院率为 6.8%（n=38）（P<0.001）。实施前术后 LOS 中位数为 6 天（四分位距，5-8 天），实施后为 5 天（四分位距，4-6 天）（P<0.001）。实施后，更多的患者出院回家，而不是疗养院（82.7%[n=461]vs 73.9%[n=261]；P=0.002）。在倾向评分匹配后，纳入 298 例均衡的患者进行分析，这些显著降低 LOS、再入院和出院去向的结果仍然存在。
新出院方案的实施与孤立性 CABG 患者的再入院率、LOS 降低以及更高的出院回家率显著相关。重要的是，结果是可持续的，不需要额外的资源，提供了高价值的护理。
