1. Dunning, Elizabeth MSN
  2. Fleisher, Mechelle
  3. Halpin, Linda MS, RN
  4. Henry, Linda PhD, RN

Article Content


This study aimed to redesign the process of postoperative/postdischarge care of the surgery patient to ensure success of the procedure (return to sinus rhythm).



Medication, rhythm management, and appropriate timing of cardioversion postprocedure are measures crucial to the success of the procedure and require collaboration of healthcare providers.



A trial fibrillation, the most common cardiac dysrhythmia in the United States, creates hemodynamic instability, decreased quality of life, and increased risk of thromboembolic events. This procedure offers the medically refractory patient a potential cure with success defined as return to normal sinus rhythm of all antiarrhythmic medications. After the first procedures were performed at our facility, uncertainty was expressed concerning patients' required postoperative/postdischarge care.



Our process redesign was a 3-phase process. Phase 1. Education for healthcare providers and patients-held 3 surgical procedure and postprocedure medication regimen "lunch and learns," development of postsurgery and postdischarge protocols, development of a surgery/cardiology interoffice collaboration for postdischarge management, and development of an educational brochure for clinicians and patients. Phase 2. Impact of this procedure on patient's quality of life. Quality of life (SF12) surveys were distributed before operation and at 3, 6, 12, and 24 months after operation. Phase 3. Clinical data collection postdischarge to confirm current rhythm, hemodynamic stability, bleeding, and the incidence of thromboembolic events.



Since September 2004, patients (N = 204) have undergone the procedure. Mean (SD) follow-up is 11.4 months (7.3 months) with a success rate of 85%. There has been a 63% increase in the number of patients following protocol. The current survey response rate is 82%. The norm-based physical function scores (quality of life) from baseline to 6 months postoperatively have increased an average of 12 points (P <.0001). Five patients (2.5%) experienced either a thromboembolic event or bleeding.



The success of the procedure is directly related to having a cohesive, collaborative process in place that begins preoperatively and continues through at least the first year after discharge.


Implications for Practice:

Starting a new procedure requires hospital care and follow-up to be designed, implemented, and coordinated among all caregivers.