title: A critical pathway for the frail elderly cardiac patient.
abstract: BACKGROUND
  The medical community needs to better respond to the predictable complexities associated with admission of frail and elderly cardiac patients who may need specific attention and care programs. The nurse practitioner can play an important role to continue and coordinate nursing and medical care. We propose a new critical pathway designed to improve cardiac and nursing care for frail elderly cardiac patients admitted with heart failure or atrial fibrillation.
  
  
  METHODS
  The critical pathway is developed by the nurse practitioner who will act as a pathway coordinator and take care of the medical care of these patients in a teaching hospital setting. This critical pathway is applied to all patients aged >75 years who are admitted for heart failure or atrial fibrillation.
  
  
  RESULTS
  The pathway implementation identified 5 important socio-medical parameters that may account for a delayed length of stay, even in patients without a complicated medical situation: delirium and fall prevention, nutritional awareness, fluid restriction efforts, and information optimization of patients and spouses.
  
  
  CONCLUSIONS
  We developed a critical care pathway for the frail elderly patients who are admitted for heart failure or atrial fibrillation. In doing so, we have been able to change the medical and social management of these patients at a general cardiology ward in a teaching hospital.
authors.affiliation: Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Wit
authors.forename: Annet
authors.initials: A
authors.lastname: Schaap
authors.forename: Victor
authors.initials: V
authors.lastname: Umans
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000451:nursing / Q000628:therapy; D016507:Cardiology Service, Hospital / Q000592:standards; D019091:Critical Pathways / Q000592:standards*; D003693:Delirium / Q000451:nursing / Q000628:therapy; D016330:Frail Elderly; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000379:methods / Q000592:standards; D006299:Health Services for the Aged / Q000458:organization & administration; D006333:Heart Failure / Q000451:nursing / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D015403:Nursing Evaluation Research / Q000379:methods; D015596:Nutrition Assessment; D057184:Practice Patterns, Nurses' / Q000592:standards*