- Email: [email protected]
EVAR for Everyone—Why and Why Not
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JOURNAL OF VASCULAR NURSING www.jvascnurs.net
Methods: A systematic review of our patient appointing process, clinic templates, care coordination both within and outside of the facility, follow-up care, and patient education was undertaken with all of our external facility and internal facility customers. A new appointing process was created, revised clinic templates were implemented, follow-up care plans were instituted at the initial patient visit, formal patient education was provided, and multidisciplinary inpatient rounds were performed. Results: Over 24 months, our surgical mortality and morbidity observed versus expected ratios (O: E ratio) decreased from 1.82 to 1.0 and from 0.97 to 0.68 respectively, the clinic noshow rate dropped from 10.6% to 7.6%, overall clinic productivity increased by 5.4% with new patient encounters increasing by 9.2%, vascular laboratory utilization increased by 5.5%, and our surgical productivity increased by 11.3%. Conclusions: Systematic review of a failed process of care, involving a multidisciplinary team of administrators, vascular technologists, nurses, midlevel providers, and physicians, can result in dramatic improvements. The result is improved patient outcomes, clinic productivity, and staff satisfaction where coordinated care is the rule, not the exception.
Program: Concurrent Session 2C
SEPTEMBER 2010
following stroke range from 26% to 52%. The presence of carotid artery atherosclerosis predisposes patients to both transient ischemic attacks (TIA’s) and strokes. Carotid endarterectomy (CEA) has been considered the gold standard for treating carotid artery stenosis as a means of preventing stroke. However, carotid angioplasty and stenting (CAS) is considered a viable alternative therapy to CEA for the treatment of carotid stenosis. Currently CAS is limited to high-risk patients; however, it is likely that its indication will be expanded for general use in the treatment of critical carotid stenosis. CAS continues to be investigated in terms of durability, stroke risk, and long term outcome. Several studies have been published to determine if CAS is at least equivalent to CEA. A pivotal study, Saphire, randomized patients to either CAS or CEA. Thirty day and one year outcomes were analyzed. The findings showed that CAS was not inferior to CEA. As technology continues to improve, this procedure is likely to become the treatment of choice in a select group of patients. Standards of care, including procedural aspects, adjuvant medical management, and appropriate surveillance have been specifically developed for CAS. This presentation will focus on the latest indications, standards, and research related to carotid angioplasty and stenting in the 21st century.
EVAR for EveryonedWhy and Why Not Elizabeth Pawlowski, RN, BScN, BSc (Hons), MHS Endovascular aneurysm repair has proven to be a viable alternative approach in repairing aneurysms of the abdominal, thoracic, and thoracoabdominal aorta. However, this procedure cannot be offered to every patient that presents with an aortic aneurysm requiring repair. Each patient must be considered on an individual basis and must be thoroughly assessed prior to embarking on an endovascular repair. This presentation will unveil the many considerations that must be reviewed prior to performing endovascular aneurysm repair, which include the anatomy of the aorta, visceral vessels and access vessels, the patient’s presenting medical condition and co-morbidities, and the feasibility of performing an open repair. Even given all of these criteria, the application of endovascular aneurysm repair is increasing. St. Michael’s Hospital in Toronto, Ontario, a designated Vascular and Endovascular Centre of Excellence in Canada, are using novel ways to manage and advance endovascular practice to challenge some of the perceived contraindications to endovascular aneurysm repair in order to ensure that endovascular aneurysm repair becomes the gold standard of care and all available to all patients presenting with an aortic aneurysm in the near future.
Program: Concurrent Session 3C Carotid Angioplasty and Stenting: Where Have We Been, Where Are We, and Where Are We Going in the 21st Century Patricia K. Bozeman, APRN, CVN Stroke is the leading cause of disability in the United States and the third leading cause of death, behind heart disease and cancer. It is estimated that stroke accounts for the majority of all hospital admissions for acute neurological disease. The mortality rates
Program: Poster 1 Are We There Yet? The Journey to Becoming a Vascular-Thoracic ICU Anne Knoll, RN, BSN, Ann Knoll, RN, BSN, Marie Desir, RN, BSN, Angela Smith, RN, BSN, Pat Rodriguez, RN, Kathy Weber, RN, Julie Fisher, RN, BSN, Maria Mattison, RN, BSN, CCRN, Lori Hadas, MSN, RN, CCRN-CSC Florida Hospital, Orlando, Florida Background and Significance: CV3 was originally designated an overflow intensive care unit for the cardiac surgical program. It lacked a dedicated staff pool and focus. Purpose: An opportunity was presented to define the 16 bed unit as a Vascular-Thoracic ICU (VT ICU). This designation was key to the development of a collaborative practice environment. The journey began with the appointment of a nursing management team and vascular medical director. Pre-op patient educators, education specialist and CNS were designated. Nursing and ancillary staff were hired for this specialty unit. An interdisciplinary Vascular Governance Committee formed to align and standardize physician and nursing practice. A vascular registry was created to measure outcomes and vascular surgical standards. Team building activities, such as softball games helped to solidify the professional relationships that were forged within the busy unit. Findings: Since the designation of the VT ICU Florida Hospital has ranked number one nationally in vascular discharges and number two for thoracic discharges. From 2006-2007 there was a 95% reduction in ventilator associated pneumonia, a 58% reduction in central line infections and have had zero for the last 12 months. There also was a 38% reduction in CDT rates. Finally, the separation rate decreased to 11%, a reduction in the amount of traveler staff and an elimination of agency staff. Discussion/Conclusions: VT ICU is now recognized as a Vascular and Thoracic center of excellence and is recognized for high
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
Methods: A systematic review of our patient appointing process, clinic templates, care coordination both within and outside of the facility, follow-up care, and patient education was undertaken with all of our external facility and internal facility customers. A new appointing process was created, revised clinic templates were implemented, follow-up care plans were instituted at the initial patient visit, formal patient education was provided, and multidisciplinary inpatient rounds were performed. Results: Over 24 months, our surgical mortality and morbidity observed versus expected ratios (O: E ratio) decreased from 1.82 to 1.0 and from 0.97 to 0.68 respectively, the clinic noshow rate dropped from 10.6% to 7.6%, overall clinic productivity increased by 5.4% with new patient encounters increasing by 9.2%, vascular laboratory utilization increased by 5.5%, and our surgical productivity increased by 11.3%. Conclusions: Systematic review of a failed process of care, involving a multidisciplinary team of administrators, vascular technologists, nurses, midlevel providers, and physicians, can result in dramatic improvements. The result is improved patient outcomes, clinic productivity, and staff satisfaction where coordinated care is the rule, not the exception.
Program: Concurrent Session 2C
SEPTEMBER 2010
following stroke range from 26% to 52%. The presence of carotid artery atherosclerosis predisposes patients to both transient ischemic attacks (TIA’s) and strokes. Carotid endarterectomy (CEA) has been considered the gold standard for treating carotid artery stenosis as a means of preventing stroke. However, carotid angioplasty and stenting (CAS) is considered a viable alternative therapy to CEA for the treatment of carotid stenosis. Currently CAS is limited to high-risk patients; however, it is likely that its indication will be expanded for general use in the treatment of critical carotid stenosis. CAS continues to be investigated in terms of durability, stroke risk, and long term outcome. Several studies have been published to determine if CAS is at least equivalent to CEA. A pivotal study, Saphire, randomized patients to either CAS or CEA. Thirty day and one year outcomes were analyzed. The findings showed that CAS was not inferior to CEA. As technology continues to improve, this procedure is likely to become the treatment of choice in a select group of patients. Standards of care, including procedural aspects, adjuvant medical management, and appropriate surveillance have been specifically developed for CAS. This presentation will focus on the latest indications, standards, and research related to carotid angioplasty and stenting in the 21st century.
EVAR for EveryonedWhy and Why Not Elizabeth Pawlowski, RN, BScN, BSc (Hons), MHS Endovascular aneurysm repair has proven to be a viable alternative approach in repairing aneurysms of the abdominal, thoracic, and thoracoabdominal aorta. However, this procedure cannot be offered to every patient that presents with an aortic aneurysm requiring repair. Each patient must be considered on an individual basis and must be thoroughly assessed prior to embarking on an endovascular repair. This presentation will unveil the many considerations that must be reviewed prior to performing endovascular aneurysm repair, which include the anatomy of the aorta, visceral vessels and access vessels, the patient’s presenting medical condition and co-morbidities, and the feasibility of performing an open repair. Even given all of these criteria, the application of endovascular aneurysm repair is increasing. St. Michael’s Hospital in Toronto, Ontario, a designated Vascular and Endovascular Centre of Excellence in Canada, are using novel ways to manage and advance endovascular practice to challenge some of the perceived contraindications to endovascular aneurysm repair in order to ensure that endovascular aneurysm repair becomes the gold standard of care and all available to all patients presenting with an aortic aneurysm in the near future.
Program: Concurrent Session 3C Carotid Angioplasty and Stenting: Where Have We Been, Where Are We, and Where Are We Going in the 21st Century Patricia K. Bozeman, APRN, CVN Stroke is the leading cause of disability in the United States and the third leading cause of death, behind heart disease and cancer. It is estimated that stroke accounts for the majority of all hospital admissions for acute neurological disease. The mortality rates
Program: Poster 1 Are We There Yet? The Journey to Becoming a Vascular-Thoracic ICU Anne Knoll, RN, BSN, Ann Knoll, RN, BSN, Marie Desir, RN, BSN, Angela Smith, RN, BSN, Pat Rodriguez, RN, Kathy Weber, RN, Julie Fisher, RN, BSN, Maria Mattison, RN, BSN, CCRN, Lori Hadas, MSN, RN, CCRN-CSC Florida Hospital, Orlando, Florida Background and Significance: CV3 was originally designated an overflow intensive care unit for the cardiac surgical program. It lacked a dedicated staff pool and focus. Purpose: An opportunity was presented to define the 16 bed unit as a Vascular-Thoracic ICU (VT ICU). This designation was key to the development of a collaborative practice environment. The journey began with the appointment of a nursing management team and vascular medical director. Pre-op patient educators, education specialist and CNS were designated. Nursing and ancillary staff were hired for this specialty unit. An interdisciplinary Vascular Governance Committee formed to align and standardize physician and nursing practice. A vascular registry was created to measure outcomes and vascular surgical standards. Team building activities, such as softball games helped to solidify the professional relationships that were forged within the busy unit. Findings: Since the designation of the VT ICU Florida Hospital has ranked number one nationally in vascular discharges and number two for thoracic discharges. From 2006-2007 there was a 95% reduction in ventilator associated pneumonia, a 58% reduction in central line infections and have had zero for the last 12 months. There also was a 38% reduction in CDT rates. Finally, the separation rate decreased to 11%, a reduction in the amount of traveler staff and an elimination of agency staff. Discussion/Conclusions: VT ICU is now recognized as a Vascular and Thoracic center of excellence and is recognized for high