Impact of implementing a cardiac surgery post-operative screening tool

Purpose

The benefit and necessity for prophylactic physiotherapy post-operatively remains unclear [1].

Combined with an increased demand on resources, scores to identify those patients who would most benefit are being increasingly used [2]. At present no validated tool exists for those following cardiac surgery.

The Birmingham cardiac surgery screening tool (BCSST) was developed to identify patients at high risk of developing post-operative pulmonary complications (PPC's).


To evaluate the effectiveness of introducing a post-operative screening tool to identify patients at risk of PPC's following cardiac surgery.

Approach

All patients undergoing cardiac surgery between 25th November and 24th December 2018 were included in the analysis.

BCSST scores were calculated on day 1 post-operatively. For patients identified as low risk, post-operative care was led by nursing staff with no physiotherapy involvement. High risk patients received standard physiotherapy input, including respiratory interventions and mobilisation.

Primary outcome was development of PPC's, assessed using the Melbourne risk prediction tool.

Outcomes

During the trial period 21/47 (42%) of patients were classified as low risk. None of the patients in the low risk group developed a PPC, although two patients were re-referred to physiotherapy (1 for mobility assessment and 1 for respiratory deterioration). Patients in the low risk group mobilised 30m earlier ( 1 day difference) and spent less time (minus 3 days) in hospital than the high risk group.
 

The BCSST was effective at identifying low risk patients, with no patients in this group developing a PPC. For these low risk patients care was safely led by nursing staff with no adverse events or falls reported.

Implications

This project has had a direct impact on cardiac post-operative physiotherapy care of patients in ITU.

Funding acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019 and ACPRC conference 2019