“It’s so simple, so inexpensive, and such common sense,” said Jocelyn Reimer-Kent, RN, MN, Clinical Nurse Specialist, Cardiac Surgery Program, Royal Columbian Hospital (RCH). “When people hear about it, their reaction is why didn’t we think about it first. It just took someone to pause and connect the clinical dots.”
Reimer-Kent was instrumental in developing the Rapid Recovery Program for cardiac surgery patients at the Royal Columbian Hospital in the Fraser Health Authority in British Columbia. The broad smile that lights up her face as she describes the program is indicative of the pride she feels towards this leading-edge care system that has gained national and international interest.
The program, first implemented six years ago at RCH, flipped traditionally reactive and illness-focused post-operative care to a wellness model. The underlying premise was that if patients are free of postoperative pain, nausea and constipation, they’ll feel remarkably well soon after heart surgery, and as a result will experience a more rapid and uncomplicated recovery.
“We used to believe it was in the patient’s best interest following cardiac surgery to keep them sedated because of pain, and when sedated, they needed to be mechanically ventilated, and to accommodate this, we had to keep them still and not activate them,” she said. “And then we waited for, and treated the side effects of surgery Ñ pain, nausea and constipation, and we were very good at that.”
In the early 90s, driven by a need to streamline care and do more with less, a cardiac surgery quality improvement team at RCH developed a rapid recovery program as a means of reducing the overall cost of care.
“Rapid recovery however, entails much more than just decreasing the time a patient spends in hospital,” Reimer-Kent said. “So we envisioned something different, and designed something innovative that would allow patients to have a safe, straight, simple and short recovery.”
The wellness model they created actually redefined care and treatment. “This approach to care has changed more than how care is delivered: it has changed the culture to one that empowers people to mend.”
“Now when I see patients doing their exercises, climbing up the required two flights of stairs and eagerly anticipating their discharge from the hospital Ñ it says volumes about how they are feeling and how they are managing their recovery,” she added.
Proof of the program’s success has come shining through. Two separate evaluations have demonstrated that the program outcomes are attainable and sustainable. In the last evaluation 133 charts were retrospectively reviewed and of these cases 95 per cent received effective pain relief, 88 per cent were free of nausea and 100 per cent were free of constipation. Reimer-Kent’s research also revealed that four days after surgery 30 to 35 per cent of coronary bypass patients were back in their homes, with no increase in either the complication rate or the re-admission rate. These efficiencies have in turn, improved access to care, as RCH now performs 600 cardiac surgical cases annually, compared to 250 in 1991.
Reimer-Kent has presented this wellness model on a number of occasions both nationally and internationally stimulating much interest. Heart centres across the country are now looking at adopting the model and a hospital in Copenhagen has purchased plans for the system.
Even within the Fraser Health Authority, surgical program teams are interested in adopting/adapting the model for many other types of surgery.
“It is a very low risk, low-tech, well-tolerated and cost effective way of delivering quality health care,” Reimer-Kent said. “No pain, great gain… for both the patient and the hospital.”