CVICU lengh of stay

pricklypear · Jun 1, 2005

Usually once lines are out, and drips are off and they remain stable for 24 hours. Our ICU is sort of slow to move people, too. Sometimes it's due to bed availablity on the floor, sometimes doctor "prefers ICU". The hospital does itself no favors by keeping people too long in ICU - insurance will only pay for it if it is indicated, and someone else will have to pick up the rest. Why are patients staying 2-3 weeks?

jetty · Jun 1, 2005

They may need to stay if they become a long term vent patient, CVVH, etc. Unfortunately our doc's want them to stay in our CVICU ( the only unit to recover fresh cabg pt's) rather than transfer to a true ICU. I was hoping for info on what other facilities do with these patients that have complications

pricklypear · Jun 1, 2005

Sorry! I didn't read your post carefully enough. It's too bad that the docs are contributing to your problem. Long term vent pts don't belong in a specialized unit like a CVICU. We only have 1 ICU, so we're stuck with everything. Good luck finding a solution.

jetty · Jun 1, 2005

Sorry! I didn't read your post carefully enough. It's too bad that the docs are contributing to your problem. Long term vent pts don't belong in a specialized unit like a CVICU. We only have 1 ICU, so we're stuck with everything. Good luck finding a solution.

thanks

babynursewannab · Jun 1, 2005

Just out of curiosity, why don't you think long-term vent pts belong in the CVICU? Mine is a 24 bed unit that houses both fresh hearts and the long-termers that don't make it out as expected. Most of those who stay are vent patients. As an ICU we are a full-care critical unit just like the others...and we have 3 other ICU's. The surgical heart pts...brand new post-op or not...belong in the surgical ICU. JMHO.

To the OP, our timeline situation is very similar to yours even though we have so many more beds than your unit. Most often than not, our hands are tied with no availability of beds on the step-down floors. The standard, though is having the patients stable and recovered and moved to tele within 24 hours...many make it there in less time when possible. Our record time for a long-term patient since I have been there was 10 weeks. None of us like to see that.

jetty · Jun 1, 2005

the unit is only an 8 bed unit and with 2 to 5 cases a day typically we don't have room for a patient that stays long term and still admit a fresh CABG. Its is a bed crunch. It would be a lot easier for the patients as well as staffing if we had a larger unit, but that is not an option currently.

pricklypear · Jun 1, 2005

Just out of curiosity, why don't you think long-term vent pts belong in the CVICU? Mine is a 24 bed unit that houses both fresh hearts and the long-termers that don't make it out as expected. Most of those who stay are vent patients. As an ICU we are a full-care critical unit just like the others...and we have 3 other ICU's. The surgical heart pts...brand new post-op or not...belong in the surgical ICU. JMHO.

After a while, surgical heart patients cease to be surgical or heart patients, and become vent dependent patients. I'm not saying that they wouldn't get good care in a CVICU, I'm just that they create the problem that jetty is having with a bed crunch in a busy unit - and could be taken care of in an MICU.

babynursewannab · Jun 2, 2005

After a while, surgical heart patients cease to be surgical or heart patients, and become vent dependent patients. I'm not saying that they wouldn't get good care in a CVICU, I'm just that they create the problem that jetty is having with a bed crunch in a busy unit - and could be taken care of in an MICU.

Understood.

It's really a continuity of care issue. However, if the beds are needed for fresh hearts, by all means, the facility should accomodate with the creation of more step-down beds for the long-termers. Not that it would actually happen in reality. :rolleyes:

zambezi, BSN, RN · Jun 2, 2005

We also need a step down unit for those heavy (pulm push/slow to progress)/vented long term patients! We have a 16 bed unit. We typically try to get out patients out on the second post op day...our patients that "fly" without difficulty we are starting to transer out the first post op to day relieve our bed crunch. We used to transfer our long termers to ICU but our surgeons don't like doing that anymore so we are hanging onto them...

heart queen · Jun 3, 2005

It's my practice that this is a common problem, due to the facility, especially the medical director allowing the cardiothoracic surgeons to have the final say as to who's appropriate for the cvicu bed. This created havoc for us.

we, management, lead nurses and the MD's to adopt to a clinical pathway for fresh open hearts... a care map of expected outcomes over a 48 hr. period. many facilities utilize this.

Your manager must buy in, then the nursing leader also the medical director, who is in CHARGE of the MD's. once in place... any patient who becomes respiratory ie long term wean (not on iabp or vad)... automatically transfers out after 72 hrs to either a respiratory ICU or the CCU. Many facilities who do more than 3 hearts with less than 10 beds move them in less time. This frees the beds for the fresh hearts.

We were forced (due to lack of buy in from the doc's) to allocate a specific # of beds per surgeon. Therefore if they didn't transfer a pt. to step down or another ICU... their heart, valve or what not was.. CANCELED... period. it was then upto that particular surgeon to beg, borrow or steal a bed from another surgeon... which rarely happened. It was no longer a nursing issue. Cancel a few hearts and they get the point quickly.

In addition, we set up a step down, specific to the cvicu who could take any extubated, unswanned (no iabp or vad) pt. 12 hrs. out.... we fast track our hearts, many done off pump and mid cab. The step down nurses only took 4 patients, and after morning rounds if beds were open (no heart transferes) they took overflow tele (usualy pre op hearts to slosh the bed).

You MUST have the proper backing in place prior to implementing.. a standardized care map for the surgeons (which they help develop) is a must for a standard to follow. getting all involved early, buy-in early is a must!

let me know what you think... ask the manager to start a committee to sole this issue.

sue