The relative benefits of pre-operative clinic vs on admission approaches to preparing patients for elective cardiac surgery

Abstract

Shortening hospital length of stay is an ever present goal of today's clinician and administrator. One way to achieve length of stay reduction in cardiac surgery is to conduct preparatory patient education via a group based pre-admission clinic rather than individually following hospital admission. The aim of this paper is therefore to compare short-term patient outcome and cost of preparing patients for cardiac surgery via a group based (pre-admission clinic) model vs individual (inpatient) model. A prospective cohort study of patient preparation for cardiac surgery (bypass graft or valve) was carried out. Two study groups were prospectively investigated: the intervention group attended pre-admission clinic one week prior to surgery (n=54); the control group was prepared individually on day of admission (n=46). Outcomes assessed were physical recovery, pain, anxiety and subjective feedback. Patients were allocated to clinic or inpatient preparation on the basis of proximity to the hospital campus. Differences in patient characteristic indicators (demographics and disease severity) between the two groups were few. Outcome comparison utilising univariate and multiple statistical procedures indicated that physical recovery, pain, anxiety and patient satisfaction indicators did not differ between those receiving preparation via the clinic (intervention group) and those receiving routine preparation (control group). Cost comparison confirmed that the clinic model yielded benefits in patient stay terms. Moving to a group context for preparing patients for cardiac surgery is therefore likely to generate equivocal short-term outcomes to standard ‘one to one’ preparation, whilst generating system cost savings.