Simple, innovative idea puts cardiac surgery patients first

By Kaylyn Ward

Physiotherapy is an essential part of post-operative care for all cardiac surgery patients. From helping prevent respiratory complications to increasing patient mobility to preparing for discharge, physiotherapists play a key role in patient care.

However, unlike their physician and nurse colleagues, physiotherapists are not typically fully staffed seven days a week in a hospital setting. Instead, they generally work Monday to Friday, with a small patient population who receive care on weekends.

This used to be the case here at Southlake Regional Health Centre’s Regional Cardiac Care Program. This schedule meant that Mondays always brought a weekend backlog of patients waiting to be assessed and prepped for discharge.

Patients who had cardiac surgery late in the week did not receive the same level of post-operative care, since our physiotherapists did not work over the weekends. Our nursing team did their best to provide some physiotherapy supports, on top of all their regular patient care duties.

We knew there had to be a better way to serve our patients. Our Clinical Services Team, which includes surgeons, anaesthesiologists, pharmacists, physiotherapists, educators, nurse practitioners, and administrators, worked collaboratively to address this challenge. The solution was very simple. We needed our physiotherapists to work on Saturdays.

In September 2012, we started providing physiotherapy on Saturday for patients who had surgery on Wednesday, Thursday, or Friday.   The goal was to keep all patients on their care pathway regardless of which day of the week they had surgery. “The impact was immediate and obvious,” said Dr. Charles Peniston, cardiac surgeon at Southlake. “It allowed us to evolve our model of care so that we could enhance and expedite the recovery of our cardiac patients.”

Patients who received expanded access to physiotherapy achieved functional milestones more quickly. These results were validated through a research project I completed as part of my Masters of Science in Physical Therapy at the University of Toronto.

This study demonstrated that the addition of Saturday physiotherapy decreased hospital length of stay for patients who had cardiac bypass surgery on a Wednesday, Thursday or Friday by an average of 0.78 days. Not only was this a positive outcome for patients, reducing length of stay by nearly one full day also led to a significant cost savings of $270,000 annually, which has been reinvested into our cardiac program.

Six-day a week physiotherapy has essentially given us more hands on deck to better serve the needs of our patients. This innovative model helped pave the way for us to introduce a new standard four-day pathway of care for cardiac surgery patients. This means that we aim to discharge patients – who meet specific health criteria – four days after their surgery.

In fact, recent data from the Canadian Institution for Health Information demonstrates that Southlake’s cardiac surgery program offers the shortest length of stay and most efficient cost per case in Ontario.

This accomplishment is very much a credit to our interprofessional model of care, where all team members practice to their full scope. We believe that our spirit of collaboration, innovation and relentless commitment to putting patients first will continue to set us apart as a leader in the delivery of cardiac care.

Kaylyn Ward, MScPT, is Manager of the cardiac surgery units (CVICU and CVS) and Cardiovascular Prevention and Rehabilitation at Southlake Regional Health Centre’s Regional Cardiac Care Program.