title: Redesigning the care of carotid endarterectomy patients.
abstract: Recent studies have supported the effectiveness of carotid endarterectomy (CEA) as a treatment for significant carotid stenosis. While the efficacy of CEA has been established, it is important to review the processes and outcomes of care to ensure high-quality, cost-effective care. As part of a quality-improvement process, our hospital's Vascular Surgery Quality Improvement Team redesigned the care for patients having CEA surgery. Practice changes, implemented in January 1995, included routine discharge on the first postoperative day; a new critical pathway supported by a computerized order set, a switch from general anesthesia to a regional block approach, and the use of an algorithm in treating postoperative hypertension. The impact of these changes on cost and quality were then analyzed. A retrospective chart audit was completed on 185 CEA surgeries performed in 1995. Length of stay decreased by 1.15 days, and costs were reduced by $1900 per case, with no change in postoperative morbidity or mortality rates. The incidence and severity of postoperative hypertension, bradycardia, and hypotension were also analyzed, supporting the practice changes and the current level of nursing care.
authors.affiliation: St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
authors.forename: K
authors.initials: K
authors.lastname: Blackburn
authors.forename: M E
authors.initials: ME
authors.lastname: Neaton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003363:Cost Control; D019091:Critical Pathways; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics / Q000451:nursing*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009731:Nursing Audit; D010351:Patient Discharge; D012189:Retrospective Studies; D017749:Total Quality Management