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N060 A Pilot Trial of a Coaching Intervention Desgined to Increase Woman's Attendance at Cardiac Rehabilitation Intake
S439
CCCN Abstracts
N060 A PILOT TRIAL OF A COACHING INTERVENTION DESGINED TO INCREASE WOMAN’S ATTENDANCE AT CARDIAC REHABILITATION INTAKE
N061 DO ALL TAVI PATIENTS REQUIRE TELEHOME MONITORING FOLLOW-UP AFTER DISCHARGE FROM HOSPITAL?
J Price
University of Ottawa Heart Institute, Ottawa, ON
Women’s College Hospital, Toronto, ON
Transcatheter aortic valve implantation (TAVI) is considered a safer option for patients with aortic stenosis deemed too high risk for conventional surgery. Consequently, most patients undergoing TAVI are frail, elderly, have multiple co-morbidities, and are at high risk for complications both in-hospital and after discharge. Currently all TAVI patients are referred to the Telehome Monitoring (THM) Program at discharge. Telehome monitoring includes the daily transmission of weight and vital signs to a central station and follow-up by an expert cardiac nurse. The purpose of this quality initiative was to examine the THM care provided to TAVI patients and thus highlight common patient characteristics that related to the need for intervention. From 2008 to February 2012, 40 patients were followed; 24 male, mean age 84.1 yrs. The majority (65%) had NYHA III; 2 had NYHA IV. Thirty-one patients (78%) had a normal ejection fraction (EF). No patients had an EF ⬍20 %. By echocardiography, 48% of patients showed diastolic dysfunction, 22% systolic dysfunction, and 30% normal function. Complications included permanent pacemaker (n⫽7), heart failure exacerbations (n⫽3), bleeding/anemia (n⫽1), access site infection/issues (n⫽3), septicemia (n⫽1), acute renal failure (n⫽1). Mean inpatient stay was 8.6 days (range 5-31). Mean duration of monitoring was 47.6 days (range 8-176 days). Patients received an average of 4.5 calls (range 1-15). Outcomes included 5 emergency visits, 7 readmissions, no deaths. Nursing interventions along with selection criteria for Telehome Monitoring follow-up will be detailed. This review reveals that THM follow-up may not be required for all TAVI patients.
Cardiovascular disease (CVD) continues to be the leading cause of death of Canadian women and while treatment for CVD has improved dramatically, women typically fare worse than men. Cardiac rehabilitation (CR) is well established as a key intervention in the treatment of coronary artery disease and has been shown to be effective in both men and women. CR remains largely underutilized, especially in women who comprise only 1224% of contemporary CR programs, even though the prevalence of CVD in men and women is similar(American Heart Association, 2009). OBJECTIVES/RESEARCH QUESTIONS: The objectives of this pilot trial were to test the feasibility of all procedures, specifically to determine: 1) an estimate of patient recruitment rates, 2) acceptability and feasibility of the intervention and 3) barriers to CR attendance and resources required. Additionally, exploratory research questions were used to determine the effects of telephone coaching on womens’ attendance at CR intake appointment, self-efficacy for cardiac exercise and self-efficacy to attend CR. METHODS: A RCT design enrolled women with CVD referred for CR at a single site in Ontario. Patients were randomized, stratified for age, to either a usual care group or an intervention group. Participants allocated to usual care received a referral to CR. In addition to usual care, women randomly assigned to the intervention group received individualized telephone coaching, designed to support self-management. RESULTS: Eighty-four patients were approached and 70 consented to participate (usual care n ⫽ 36, intervention n ⫽ 34). Participants were highly satisfied with their coaching experience; they found the information provided to be helpful with goal setting, action planning and assisted them in their interactions with their health care providers. Participants received three to five calls prior to CR intake appointment and the telephone calls were generally less than 28 minutes in duration (n ⫽ 118, 99%). Barriers to attendance identified included transportation, health concerns, timing and lack of physician endorsement. Most common resources identified included problem solving support, assistance with communication with physicians and information concerning CR. Participants in the intervention group were significantly more likely to attend CR intake (p ⫽ 0.048). SIGNIFICANCE/IMPLICATIONS: The evidence obtained from this pilot trial suggests that a telephone coaching intervention designed to enhance self-management is feasible and may improve attendance at CR intake for women following hospital discharge with a cardiac event. BACKGROUND/RATIONALE:
C Struthers, K Eastwood, L Montoya, M Labinaz, M Ruel
N062 THE IMPLEMENTATION OF A MODIFIED EARLY WARNING SCORE (MEWS) SYSTEM ON AN INPATIENT CARDIAC MEDICINE UNIT: A QUALITY IMPROVEMENT INITIATIVE C Talusan, A Fong, J Knoll, H Andrews, J Carne, M Mackay Providence Health Care, Vancouver, BC
Literature on deterioration of patients in hospital shows that adverse events are frequently preceded by changes in physiological parameters. Subtle, but significant changes in these parameters may be apparent 8 to 12 hours prior to an adverse event. The Modified Early Warning Score (MEWS) System was designed to assist health care professionals to identify and track early deterioration of patients based on five physiological parameters: 1) blood pressure, 2) heart rate, 3) respiratory rate, 4) temperature and 5) level of consciousness. Each parameter is
CCCN Abstracts
N060 A PILOT TRIAL OF A COACHING INTERVENTION DESGINED TO INCREASE WOMAN’S ATTENDANCE AT CARDIAC REHABILITATION INTAKE
N061 DO ALL TAVI PATIENTS REQUIRE TELEHOME MONITORING FOLLOW-UP AFTER DISCHARGE FROM HOSPITAL?
J Price
University of Ottawa Heart Institute, Ottawa, ON
Women’s College Hospital, Toronto, ON
Transcatheter aortic valve implantation (TAVI) is considered a safer option for patients with aortic stenosis deemed too high risk for conventional surgery. Consequently, most patients undergoing TAVI are frail, elderly, have multiple co-morbidities, and are at high risk for complications both in-hospital and after discharge. Currently all TAVI patients are referred to the Telehome Monitoring (THM) Program at discharge. Telehome monitoring includes the daily transmission of weight and vital signs to a central station and follow-up by an expert cardiac nurse. The purpose of this quality initiative was to examine the THM care provided to TAVI patients and thus highlight common patient characteristics that related to the need for intervention. From 2008 to February 2012, 40 patients were followed; 24 male, mean age 84.1 yrs. The majority (65%) had NYHA III; 2 had NYHA IV. Thirty-one patients (78%) had a normal ejection fraction (EF). No patients had an EF ⬍20 %. By echocardiography, 48% of patients showed diastolic dysfunction, 22% systolic dysfunction, and 30% normal function. Complications included permanent pacemaker (n⫽7), heart failure exacerbations (n⫽3), bleeding/anemia (n⫽1), access site infection/issues (n⫽3), septicemia (n⫽1), acute renal failure (n⫽1). Mean inpatient stay was 8.6 days (range 5-31). Mean duration of monitoring was 47.6 days (range 8-176 days). Patients received an average of 4.5 calls (range 1-15). Outcomes included 5 emergency visits, 7 readmissions, no deaths. Nursing interventions along with selection criteria for Telehome Monitoring follow-up will be detailed. This review reveals that THM follow-up may not be required for all TAVI patients.
Cardiovascular disease (CVD) continues to be the leading cause of death of Canadian women and while treatment for CVD has improved dramatically, women typically fare worse than men. Cardiac rehabilitation (CR) is well established as a key intervention in the treatment of coronary artery disease and has been shown to be effective in both men and women. CR remains largely underutilized, especially in women who comprise only 1224% of contemporary CR programs, even though the prevalence of CVD in men and women is similar(American Heart Association, 2009). OBJECTIVES/RESEARCH QUESTIONS: The objectives of this pilot trial were to test the feasibility of all procedures, specifically to determine: 1) an estimate of patient recruitment rates, 2) acceptability and feasibility of the intervention and 3) barriers to CR attendance and resources required. Additionally, exploratory research questions were used to determine the effects of telephone coaching on womens’ attendance at CR intake appointment, self-efficacy for cardiac exercise and self-efficacy to attend CR. METHODS: A RCT design enrolled women with CVD referred for CR at a single site in Ontario. Patients were randomized, stratified for age, to either a usual care group or an intervention group. Participants allocated to usual care received a referral to CR. In addition to usual care, women randomly assigned to the intervention group received individualized telephone coaching, designed to support self-management. RESULTS: Eighty-four patients were approached and 70 consented to participate (usual care n ⫽ 36, intervention n ⫽ 34). Participants were highly satisfied with their coaching experience; they found the information provided to be helpful with goal setting, action planning and assisted them in their interactions with their health care providers. Participants received three to five calls prior to CR intake appointment and the telephone calls were generally less than 28 minutes in duration (n ⫽ 118, 99%). Barriers to attendance identified included transportation, health concerns, timing and lack of physician endorsement. Most common resources identified included problem solving support, assistance with communication with physicians and information concerning CR. Participants in the intervention group were significantly more likely to attend CR intake (p ⫽ 0.048). SIGNIFICANCE/IMPLICATIONS: The evidence obtained from this pilot trial suggests that a telephone coaching intervention designed to enhance self-management is feasible and may improve attendance at CR intake for women following hospital discharge with a cardiac event. BACKGROUND/RATIONALE:
C Struthers, K Eastwood, L Montoya, M Labinaz, M Ruel
N062 THE IMPLEMENTATION OF A MODIFIED EARLY WARNING SCORE (MEWS) SYSTEM ON AN INPATIENT CARDIAC MEDICINE UNIT: A QUALITY IMPROVEMENT INITIATIVE C Talusan, A Fong, J Knoll, H Andrews, J Carne, M Mackay Providence Health Care, Vancouver, BC
Literature on deterioration of patients in hospital shows that adverse events are frequently preceded by changes in physiological parameters. Subtle, but significant changes in these parameters may be apparent 8 to 12 hours prior to an adverse event. The Modified Early Warning Score (MEWS) System was designed to assist health care professionals to identify and track early deterioration of patients based on five physiological parameters: 1) blood pressure, 2) heart rate, 3) respiratory rate, 4) temperature and 5) level of consciousness. Each parameter is