CV Directions Vol. 2, No. 1 - Page 2

AUTHORS Editor in Chief Phalan L. Bolden, MSN, FNP Peggy McElgunn, Esq., Executive Director Sanger Heart & Vascular Institute Latasha S. Ruffin, DPT, PT Carolinas Medical Center Contributing Editor — Quality Mary Heisler, ACE REDUCING LENGTH-OF -STAY POST AMPUTATION According to the CDC, in 2009, the average length of stay for non-traumatic lower extremity amputations was 9.8 days. The arithmetic average length of stay at Carolinas Medical Center for non-traumatic below knee amputation from September 2012- August 2013 was 17.78 days. The purpose of the Vascular Amputation Task Force was to develop a pathway that involved members of the multidisciplinary team for a holistic approach in delivering consistent, effective and efficient quality of care to patients post amputation. To supersede the data released in 2009 and the CDC statistics for the average length of stay for lower extremity amputations, the goal was to decrease the length of stay from surgery to discharge to three days. Contributing Editor — Technology Ike Miller, Carolinas Medical Center focused education on transfers, positioning, and contracture prevention. Results have shown that the implementation of PCA preoperatively for pain management has led to better functional outcomes. Contributing Editor — Reimbursement / Finance The collaboration of care between physical/ occupational therapy, the liaison with volunteer support services, close co-morbidity monitoring, (i.e. diabetic screening, lipid profiling, pain control), has contributed to the efficient discharge to appropriate disposition with the help of case management. Contributing Editor — Administrative Matters The timeliness of feedback with self-audit results, the use of rapid cycle of Plan-DoStudy–Act Model for Performance Improvement, the tangible support of administration, the setting of co-leadership, and the leveraging of the practice in this new process were all innovative ingredients in the success of this initiative. Information on Peripheral Arterial Disease Throughout the pilot process, changes in regards to timeliness of consultations and pain control were made based on the needs of the patients. As a result of this standardization, care for patients post amputation has become more effective, thus reducing the timeframe from admittance to discharge to the appropriate disposition. The program reduced length of stay from 17.78 days to 9 days for the below knee amputation population and from 7.46 days to 5.66 days in the above knee amputation population. This reduction provides savings of $2,247.00 per day in room cost alone. The pathway has provided timely patient care and improved quality of care through Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities. PAD is a major risk factor for lower-extremity amputation. The disease also suggests a high likelihood for symptomatic cardiovascular and cerebrovascular disease. David Strelow, MidAmerica-St. Luke’s Jon Gardner, Centura Contributing Editor — Research & Evidence Practice Linda Paxton, Chippenham Johnston Willis Advertising Director Sean McElgunn, VP Corporate Relations Managing Editor Kurt Jensen, Communications Director For more information on PAD compiled by authors Bolden and Ruffin, visit the Alliance of Cardiovascular Professionals’ blog at acp-online.org/blog. 2