Abstract P310: Delayed Discharge in Cardiothoracic Surgical Practice - Do Our Patients Just Not Want to Go Home?

Aims: Patient discharge after non-emergent adult cardiac surgery is influenced by many medical and social factors. Delayed discharge is often due to identifiable and rectifiable factors. This resultant shortened hospital stay allows for more patients to be treated along with lower economic costs incurred in hospital. Patient care guidelines developed enable uniformity of care along with improved efficiency of care. Methods: Prospective analysis of data collected at a tertiary level cardiac centre (over 2000 cases/year) in 2008 of urgent and elective adult cardiac surgical cases was compared to UK national length of stay published data. Type of operation, postoperative progress along with factors influencing discharge (physiotherapy, discharge destination, etc) and length of stay were reviewed with weaknesses identified and improvements instituted. Savings of even 1 day/patient produces over $1 million/year to the hospital. Results: Data on 220 consecutive admisisons collected (11%, 220 of 2004) of which 175 (80%) were elective and 45 (20%) urgent. Their mean age was 68, BMI 28.6 and 163 (74%) were male. Their mean EuroSCORE was 5.18 with a log EuroSCORE was 6.61%. CABG, valve repair/replacement or a combination of the two accounted for 195 (89%) with complex procedures in the remainder. There were 5 deaths (2%). Mean critical care stay was 2 days with postoperative checks completed between days 4-6. Length of stay (days) noted to be 8.7, 7.9, 8.2 and 12.0 in all, CABG, isolated valve and valve plus grafts respectively. This discharge data was keeping with national data. Clinician related variation in postoperative progress, limitations in carer availability, anticoagulation services, weekend physiotherapy services were identified as limiting factors. Conclusions: Delayed discharge is multi-factorial. Our patient population is older with complex surgical problems with identifiable factors that delay discharge. Improved preoperative work-up, with planned convalescence options are essential to efficient care. Protocol driven progress, improved staffing, coordination with local teams, improved physiotherapy cover with a dedicated cardiac surgery discharge coordinator are improvements developed since this review.