Faculty Collaboration Database

Acuity adaptable patient care unit system shortens length of stay and improves outcomes in adult cardiac surgery: University of Wisconsin experience. Eur J Cardiothorac Surg 2014 Jul;46(1):49-54

Date

01/11/2014

Pubmed ID

24408899

DOI

10.1093/ejcts/ezt582

Scopus ID

2-s2.0-84903761411 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

OBJECTIVES: The Acuity Adaptable Patient Care (AAC) unit system allows all beds within a nursing unit to negate the need for transfer with changes in patient status. The unit is specialty specific to all levels of patient care. This system was implemented in March 2006 for cardiothoracic surgery at our institution. The purpose of this study was to evaluate the impact of the AAC system on the outcomes after adult cardiac surgery.

METHODS: We retrospectively reviewed 2930 consecutive patients who underwent major adult cardiac procedures between January 2003 and December 2010. The cohorts were divided into the pre-AAC group (January 2003 to February 2006, n = 1029) and the AAC group (March 2006 to December 2010, n = 1901). Patient demographics and postoperative outcomes were assessed.

RESULTS: The proportion of coronary artery bypass grafting was significantly lower (pre-AAC vs AAC: 43 vs 35%, P < 0.01), while those of aortic procedure (4 vs 11%, P < 0.01) and mechanical assist device insertion (3 vs 5%, P = 0.02) were higher in the AAC group. After the implementation of the AAC system, the incidence of all complications defined by the Society of Thoracic Surgeons (STS) database (49 vs 34%, P < 0.01), the median length of intensive care unit (ICU) stay (49 [interquartile range (IQR), 27-99] vs 26 [19-45] h, P < 0.01), that of hospital stay (6 [4-10] vs 5 [4-7] days, P < 0.01) and the readmission rate of ICU (5 vs 2% P < 0.01) were significantly decreased. Significant reductions in hospital mortality and the rate of hospital readmission <30 days were not observed.

CONCLUSIONS: The implementation of the AAC system has improved the outcomes after major cardiac procedures. The incidence of postoperative complications and length of stay have all decreased significantly without increasing readmission rate. AAC creates a system of fluid care with specialty-trained nursing and other ancillary support that expedites discharge and improves overall patient outcomes.

Author List

Chindhy SA, Edwards NM, Rajamanickam V, Lushaj EB, Lozonschi L, De Oliveira NC, Kohmoto T, Osaki S

Author

Takushi Kohmoto MD, PhD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiovascular Surgical Procedures
Cohort Studies
Female
Hospital Mortality
Hospital Units
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Patient Acuity
Patient Readmission
Perioperative Nursing
Postoperative Care
Postoperative Complications
Retrospective Studies
Wisconsin