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The effect of a 'fast-track' unit on the performance of a cardiothoracic department
L Hadjinikolaou1, A Cohen, B Glenville
1St Mary's Hospital, London, UK. leonhn@otenet.gr
Insights
Implementing a fast-track unit and computerized system significantly boosted cardiothoracic operating numbers and financial income. This innovation improved efficiency without negatively impacting patient outcomes or mortality rates.
Area of Science:
- Cardiothoracic Surgery
- Health Informatics
- Healthcare Management
Background:
- Cardiothoracic departments face challenges in optimizing clinical practice and financial performance.
- Implementing specialized units and information systems can address these challenges.
Purpose of the Study:
- To evaluate the impact of a fast-track unit and computerized system on clinical practice and finance in a cardiothoracic department.
- To assess changes in operating numbers, financial income, patient recovery, and operative mortality.
Main Methods:
- A 3-bed fast-track unit was established with a computerized system for planning and a pre-admission clinic.
- Data from 642 major cardiothoracic cases over 12 months were analyzed.
- Key outcomes included operating numbers, financial income, patient recovery, and operative mortality.
Main Results:
- Operating numbers increased by 11.3% and financial income by 38%.
- 81.8% of patients were scheduled for the fast-track unit, with 93.7% successfully managed.
- Coronary artery bypass grafting showed low failure rates; re-do operations had higher failure rates.
Conclusions:
- The fast-track unit and computerized system substantially improved operating numbers and financial income.
- Clinical results were not adversely affected, demonstrating enhanced efficiency.
- Appropriate patient selection is key to further optimizing fast-track unit efficiency.
Objective:
The objective of this study was to describe the impact of a 'fast-track' unit, combined with a computerised system for information collection and analysis, on the clinical practice and finance of a cardiothoracic department over the first 12 month period of its application.
Methods:
Within 12 months, starting December 1996, 642 major cardiothoracic cases were performed at the Cardiothoracic Department, St Mary's Hospital, London, after the establishment of a 3-bed 'fast-track' unit, which was supported by a computerised system for admission planning and a pre-admission clinic. The main outcome measures were operating numbers, financial income, patient recovery and operative mortality.
Results:
The 'fast-track' unit resulted in an increase of the operating numbers (11.3% increase in major cardiac cases) and income (38%), as compared with the year before. Some 525 patients out of 642 (81.8%) were scheduled for the 'fast-track' unit and 492 (93.7%) were successfully 'fast-tracked'. Coronary artery bypass grafting operations had the lowest 'fast-track' failure and mortality rates. Re-do operations and complex coronary procedures presented a high 'fast-track' failure rate of approximately 20-25%. Low cardiac output, postoperative bleeding and respiratory problems were the most frequent causes for 'fast-track' failure.
Conclusions:
The development of a 'fast-track' unit, supported by a computerised system for information collection and analysis and a pre-admission clinic, has resulted in a substantial improvement of operating numbers and financial income, without adversely affecting the clinical results. This task demanded close collaboration between a dedicated list manager and a designated member of the medical team. Patient selection with appropriate 'fast-track,' criteria may improve further the efficiency of 'fast-track' units in the future.