Safety and efficacy of a nurse-led clinic for post-operative coronary artery bypass grafting patients

BACKGROUND: New opportunities are emerging for nurses as sovereign health care specialists. In accordance with British and American experience, several universities on the European Continent started Advance Nursing Practice programs for nurses to become certified nurse specialists, functioning as intermediates between the consultant, the ward nurse and the patient. AIMS: This observational study was conducted to evaluate safety and efficacy of a nurse-led clinic for patients recovering after a successful coronary artery bypass grafting operation. METHODS: From April 1999 to June 2002, 584 consecutive patients underwent a coronary artery bypass graft operation after which they were admitted to the cardiology ward. Subsequently, these patients were treated either by a certified nurse practitioner or by a resident. Both were supervised by an attending cardiologist. The study elapses three time phases: phase I (1999) first control period, phase II (2000-2002) the nurse practitioner was in charge, and phase III (2002) the second control period. RESULTS: A total of 584 patients were admitted at a mean of 5.5 and 6.3 days after the operation (phase II vs I+III, respectively). Typically these patients were men (79%) with a mean age of 67+/-11 years. During the observation period, 349 patients were treated by the nurse practitioner and 235 by a resident (89 in phase I and 146 in phase III). Two patients suddenly died while admitted. All other patients recovered and were discharged. The nurse-treated patients (phase II) were discharged significantly sooner than those treated by the regular staff (11.5 vs 14.7 days; p<0.001, respectively). The 30-day mortality rate was 0.4% and did not differ between the respective patient or time-phase groups. CONCLUSION: A nurse-led clinic for patients recovering from a coronary artery bypass graft operation was safely and efficaciously introduced in a large Dutch non-cardiac surgery hospital. This study protocol may serve as a preamble for upcoming nurse-led programs to developed and implement the sovereign care by nurse practitioners for various diseases and in different settings.