October 22, 2024
In early June 2024, the Cardiac Surgery Recovery Unit (CSRU) at London Health Sciences Centre (LHSC) was renamed the Cardiac Surgery Intensive Care Unit (CSICU). This change was made to more accurately reflect the high-quality tertiary care, or specialized care, provided to patients who have undergone open heart surgical procedures and to align with similar units at our peer hospitals.
The previous surgical recovery profile did not allow for recognition of the ICU component of care the unit provides. The team often finds themselves providing care for patients that extends beyond cardiac surgery recovery support.
Even though the name of the unit may have changed, the quality and efficiency of care has continued. The unit is proud of the work the team does on a daily basis and has graciously opened their doors to allow a look inside their daily operations.
7:00 a.m.
The nursing team will debrief the incoming team on patients and transfer care over to the daytime team. The CSICU is a very busy area with up to a maximum of eight surgeries per day, and with 14 beds, there is a lot of movement in and out of this unit.
Kathy Lippert, Charge Nurse, comments that a main priority for the team is making sure it is appropriate for patients to move to other units. “It takes a lot of organization to prepare for the movement of these patients”.
Dr. Daniel Bainbridge, Medical Director of CSICU, has a similar priority. He arrives at 7:30 a.m. to make initial rounds and see where patients are in their care, while also determining who needs additional attention, knowing that some of these patients might be moving up to inpatient units soon.
9:00 a.m.
After first vital checks and rounds with patients, multidisciplinary teams will gather every morning around 9 a.m. and conduct bedside rounds to discuss the patient and their needs.
(Dr. Daniel Bainbridge; Denise Fluttert, RN; Kenda Smith, RN and Kathy Lippert, RN;)
Dr. Bainbridge adds, “We often have a few nurse practitioners, a few residents or fellows, pharmacy, respiratory therapists for ventilator purposes, and physiotherapists that complete these rounds with us. From there, the team is either preparing patients to move up to the cardiac inpatient unit or focusing on any issues that may arise throughout the day”.
Kathy Lippert, RN explains, “Our daily work is intensive care because we have such an interdisciplinary team managing care for a range of patients and systems to ensure they have the best recovery.”
Noon
CSICU begins receiving its first patients from that morning’s surgeries between noon and 3:30 p.m. “Patients generally come to us still on ventilators directly from the operating room and we monitor their readiness to be extubated and monitor all vitals after a surgery of this magnitude,” Kathy explains.
3:30 p.m.
The evening team starts to arrive around 3:30, and conducts another set of rounds.
Denise Fluttert, RN, adds, “A large aspect of our job is making sure patients are stabilized, assisting with pain management and then preparing them to get ready for the cardiac inpatient unit.”
If a patient is stable, the team will try to extubate them fairly quickly and work towards removing any extra medications and getting them mobilized (i.e. sitting at the side of the bed). If everything goes well throughout the day, patients will then move to the inpatient floor.
5:30 p.m.
The evening team will begin to receive patients from the afternoon procedures between 5:30 p.m. and 8:00 p.m. Throughout the afternoon, the unit is busy preparing for the movement of patients, whether it is for incoming patients or patients moving to inpatient units for the remainder of their recovery.
Dr. Bainbridge mentions that the most common procedures the CSICU unit sees are coronary bypass and valve surgeries, while rarer cases include heart transplants (15-20 a year) and aortic dissections. CSICU also treats many patients with additional medical concerns beyond cardiac treatment, which makes an interdisplinary team all that more important. “You can’t impact the heart and the cardiac system without impacting other parts of the body,” says Lippert.
The nursing skill level and patient complexity are of higher acuity in this unit, requiring nurses to have specialized training and competencies in specific areas. Nurses are also certified in various technologies that patients may need during their stay, such as ventricular assist devices, dialysis, and ECMO.
Excited about the future of cardiac care, Bainbridge highlights advances in minimally invasive surgeries, stating, “We have one of Canada's leaders in mitral valve surgery and were the first to perform minimally invasive robotic surgery." He adds that these procedures are becoming quicker, less invasive, and offer better patient outcomes.
Lippert continues, “There are new things every day – new medications, new procedures, so it's never really the same.”
The team remains dedicated to supporting patients throughout their stay, whether for one day or six months, with Bainbridge emphasizing, “Our goal is to get you well enough to continue healing on your own and we support both patients and families every step of the way.” The team share their pride in the bonds they form with long-term patients, saying, “It is a very special and rewarding experience to see a patient sedated for weeks and be part of their recovery to see them walking in the halls”.
The renaming of this unit emphasizes the importance of teamwork and interdisplinary collaboration in delivering quality care for patients. This new designation not only aligns with industry standards but also highlights the team’s commitment to integrating diverse expertise for optimal patient outcomes.