title: Bridging the care continuum for open heart surgery patients.
abstract: A pilot program followed patients who were recovering from coronary artery bypass graft procedures. A cardiac surgery nurse visits patients in their homes to provide physical assessments, reinforce discharge teaching and answer questions. Because of the pilot's success, the program was integrated with the transitional open heart unit.
authors.affiliation: Patient Care Services, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Capuano
authors.forename: R
authors.initials: R
authors.lastname: Barber
authors.forename: K
authors.initials: K
authors.lastname: Sullivan
mesh_terms: D000359:Aftercare / Q000458:organization & administration*; D003266:Continuity of Patient Care; D001026:Coronary Artery Bypass / Q000451:nursing*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010351:Patient Discharge; D010353:Patient Education as Topic; D010865:Pilot Projects