Inpatient Wait for Urgent Cardiac Surgery: The Patients' Perspective

Edward J. Caruana ¹, Hey Cong ², Sendhil K. Balasubramanian ¹, Adam Szafranek ¹

¹ Nottingham University Hospitals, Nottingham, United Kingdom; ² Medical School, University of Nottingham, Nottingham, United Kingdom;

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objectives

Procedures designated ‘urgent’, wherein patients remain in-hospital between presentation and definitive treatment, account for a third of the cardiac surgical workload in the United Kingdom. It is not known to what extent this inpatient wait is justified. We sought to evaluate the patient experience and perspective on this complex, multi-faceted issue.

Methods

Convenience-sampling from 50 postoperative patients who underwent urgent cardiac surgery at a single UK centre between October 2016 and September 2017, recruited voluntarily to a structured telephone interview. Quantitative ratings are on a 10-point scale. Statistical analysis was performed in Microsoft Excel 365 with the Anlalyse-it® add-on.

Results

43 patients - 65% (n=28) male, age 68±13 years (mean±SD) - completed the interview. 47% (23/43) felt that they were reviewed only intermittently, or simply as a formality, during the preoperative period. 12% (5/43) experienced cardiac symptoms requiring medical attention preoperatively. The worst score across mobility, diet, sleep quality and mood during this period was 4.3±2.1. 44% (19/43) felt that they understood the risks of waiting for their operation at home, however, no patient could recall any specific risks. Only 25% (11/43) expressed a retrospective preference to have waited at home; likely informed by an aversion to the possibility of needing urgent readmission (unacceptable to 77% (33/43)), and a perception that their procedure would have been further delayed (84% (36/43)).

Conclusions

The incidence of subjectively-reported pre-operative events requiring medical intervention is low in our ‘urgent’ inpatient-wait cohort. The patient experience is poor in at least one key area; however, patients are reassured by being in hospital. There is need for better objective evidence to indicate inpatient-wait for urgent cardiac surgery; and emphasis on patient education in this regard.